Healthcare Provider Details

I. General information

NPI: 1023094091
Provider Name (Legal Business Name): AMY M BYERLY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7740 WASHINGTON VILLAGE DR STE 100
CENTERVILLE OH
45459-3994
US

IV. Provider business mailing address

7740 WASHNGTON VLG DR SUITE 100
CENTERVILLE OH
45459-4056
US

V. Phone/Fax

Practice location:
  • Phone: 379-433-4325
  • Fax: 937-439-7445
Mailing address:
  • Phone: 937-531-7900
  • Fax: 937-531-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34007414
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: