MEDICARE: AMANI R DEVAUGHN-MILLER

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	103TM1800X	Intellectual & Developmental Disabilities Psychologist

General Provider Information

NPI Number	:	1629964127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANI R DEVAUGHN-MILLER

Provider Business Mailing Address
First Line	:	2670 LEHMAN RD APT 201D
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45204-1856
Country	:	US
Telephone Number	:	513-390-6450
Fax Number	:

Provider Business Practice Location Address
First Line	:	2670 LEHMAN RD APT 201D
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45204-1856
Country	:	US
Telephone Number	:	513-390-6450
Fax Number	:

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

Provider Enumeration Date	:	06/13/2025
Last Update Date	:	06/13/2025

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