Healthcare Provider Details

I. General information

NPI: 1417779968
Provider Name (Legal Business Name): AMANDA P SIFUENTES-SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 01/04/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MERCY DR
DUBUQUE IA
52001-7320
US

IV. Provider business mailing address

2000 UNIVERSITY AVE
DUBUQUE IA
52001-5099
US

V. Phone/Fax

Practice location:
  • Phone: 563-589-9666
  • Fax:
Mailing address:
  • Phone: 563-589-3662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: