Healthcare Provider Details

I. General information

NPI: 1326390857
Provider Name (Legal Business Name): AMANDA FRAYER SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 ALBRIGHT ST
TAOS NM
87571-6312
US

IV. Provider business mailing address

105 PASEO DEL CANON W STE A
TAOS NM
87571-6943
US

V. Phone/Fax

Practice location:
  • Phone: 575-613-6002
  • Fax:
Mailing address:
  • Phone: 575-737-5533
  • Fax: 575-737-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: