Healthcare Provider Details

I. General information

NPI: 1497754014
Provider Name (Legal Business Name): AMANDA MAN WU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date: 03/18/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

4028 TAMPA RD
OLDSMAR FL
34677-3205
US

IV. Provider business mailing address

16308 TURNBURY OAK DR
ODESSA FL
33556-2872
US

V. Phone/Fax

Practice location:
  • Phone: 813-814-9088
  • Fax: 813-814-9077
Mailing address:
  • Phone: 813-814-9088
  • Fax: 813-814-9077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME82723
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: