Healthcare Provider Details

I. General information

NPI: 1922085356
Provider Name (Legal Business Name): RENEE AMATO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12345 W BEND DR SUITE 300
SAINT LOUIS MO
63128-2182
US

IV. Provider business mailing address

PO BOX 23340
SAINT LOUIS MO
63156-3340
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-6000
  • Fax: 314-849-1417
Mailing address:
  • Phone: 314-849-6000
  • Fax: 314-849-1417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2005033632
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: