Healthcare Provider Details

I. General information

NPI: 1558890715
Provider Name (Legal Business Name): AMANDA L SADLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA STEVENS MD

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 SW 4TH ST STE 105
MOORE OK
73160-4946
US

IV. Provider business mailing address

519 SW 4TH ST STE 105
MOORE OK
73160-4946
US

V. Phone/Fax

Practice location:
  • Phone: 405-237-9503
  • Fax: 405-900-9507
Mailing address:
  • Phone: 405-237-9503
  • Fax: 405-900-9507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number32903
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32903
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDR.0066841
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: