Healthcare Provider Details

I. General information

NPI: 1134016991
Provider Name (Legal Business Name): AMANDA MADDREY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 26TH AVE E
BRADENTON FL
34208-7753
US

IV. Provider business mailing address

1235 CANTERBURY RD
CLEARWATER FL
33764-4815
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4600
  • Fax:
Mailing address:
  • Phone: 727-776-1320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberUO11172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: