Healthcare Provider Details

I. General information

NPI: 1356728513
Provider Name (Legal Business Name): AMANDA DEWBRAY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 S VAL VISTA DR STE 146
GILBERT AZ
85295-1675
US

IV. Provider business mailing address

2730 S VAL VISTA DR STE 146
GILBERT AZ
85295-1675
US

V. Phone/Fax

Practice location:
  • Phone: 480-505-3838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4574
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: