MEDICARE: DR. AMY SUPORN ASANDRA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	Q3847	TX
2	2085R0202X	Diagnostic Radiology Physician	A108663	CA
3	2085R0204X	Vascular & Interventional Radiology Physician	A108663	CA
4	2085R0204X	Vascular & Interventional Radiology Physician	Q3847	TX

General Provider Information

NPI Number	:	1588860159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY SUPORN ASANDRA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-5347
Country	:	US
Telephone Number	:	214-645-8920
Fax Number	:

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7201
Country	:	US
Telephone Number	:	214-645-8920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	12/17/2025

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