Healthcare Provider Details

I. General information

NPI: 1356954572
Provider Name (Legal Business Name): AMELIA SUE WYKES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S MAIN ST
FINDLAY OH
45840-1214
US

IV. Provider business mailing address

13088 TOWNSHIP ROAD 150
ARLINGTON OH
45814-9768
US

V. Phone/Fax

Practice location:
  • Phone: 419-423-4500
  • Fax:
Mailing address:
  • Phone: 419-619-6438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number50.006587
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number50.006587RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: