Healthcare Provider Details

I. General information

NPI: 1316237126
Provider Name (Legal Business Name): AMY LYN SANDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY SANDERSON NIETUPSKI MD

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 SANTA FE DR
ENCINITAS CA
92024-5142
US

IV. Provider business mailing address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

V. Phone/Fax

Practice location:
  • Phone: 760-633-7686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number127750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: