Provider Demographics
NPI:1831368307
Name:CARRION, AMANDA E (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:CARRION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:954-493-6496
Mailing Address - Fax:954-493-6726
Practice Address - Street 1:6181 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-2227
Practice Address - Country:US
Practice Address - Phone:954-493-6496
Practice Address - Fax:954-493-6726
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010011909208000000X, 2080P0204X
FLME119669208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO103810130Medicaid
FL011690700Medicaid