MEDICARE: AMANDA DAWN DAMIRIS PA-C

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	363A00000X	Physician Assistant	4551	AZ

General Provider Information

NPI Number	:	1871829184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA DAWN DAMIRIS PA-C

Provider Business Mailing Address
First Line	:	6740 E CAMELBACK RD
Second Line	:	SUITE #102
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-2096
Country	:	US
Telephone Number	:	480-656-0291
Fax Number	:	480-656-0127

Provider Business Practice Location Address
First Line	:	6740 E CAMELBACK RD
Second Line	:	SUITE #102
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-2096
Country	:	US
Telephone Number	:	480-656-0291
Fax Number	:	480-656-0127

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

Provider Enumeration Date	:	10/21/2009
Last Update Date	:	11/13/2015

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