Healthcare Provider Details

I. General information

NPI: 1760223176
Provider Name (Legal Business Name): AMY MICELI DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 11/20/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PENN STATE HEALTH HOLY SPIRIT MEDICAL CENTER 503 N. 21ST STREET
CAMP HILL PA
17011-2204
US

IV. Provider business mailing address

1312 STRAFFORD RD
CAMP HILL PA
17011-6206
US

V. Phone/Fax

Practice location:
  • Phone: 717-763-2100
  • Fax:
Mailing address:
  • Phone: 717-439-1766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. AMY LYNN LOUISE MICELI
Title or Position: OWNER
Credential: DPM
Phone: 717-439-1766