Healthcare Provider Details

I. General information

NPI: 1447204441
Provider Name (Legal Business Name): AMY E CICCIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 E NORTH AVE
BELTON MO
64012-5105
US

IV. Provider business mailing address

8800 W 75TH ST STE 140
SHAWNEE MISSION KS
66204-4001
US

V. Phone/Fax

Practice location:
  • Phone: 816-322-6100
  • Fax: 913-362-0407
Mailing address:
  • Phone: 913-362-3210
  • Fax: 913-362-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2006019869
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: