Healthcare Provider Details

I. General information

NPI: 1497692438
Provider Name (Legal Business Name): AMANDA DELLAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 4TH ST STE C
EUREKA MO
63025-1839
US

IV. Provider business mailing address

300 W 4TH ST STE C
EUREKA MO
63025-1839
US

V. Phone/Fax

Practice location:
  • Phone: 636-579-4800
  • Fax:
Mailing address:
  • Phone: 636-579-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2026018318
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: