Provider Demographics
NPI:1821884990
Name:UNDERWOOD, AMOY
Entity type:Individual
Prefix:
First Name:AMOY
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12365 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-2517
Mailing Address - Country:US
Mailing Address - Phone:954-326-6650
Mailing Address - Fax:
Practice Address - Street 1:12365 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2517
Practice Address - Country:US
Practice Address - Phone:954-326-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide