Healthcare Provider Details

I. General information

NPI: 1295931715
Provider Name (Legal Business Name): AMANDA N ALVELO-MALINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 N JOSEY LN STE 223
CARROLLTON TX
75007-3150
US

IV. Provider business mailing address

3465 BLOSSOM LN
BLOOMFIELD HILLS MI
48302-1306
US

V. Phone/Fax

Practice location:
  • Phone: 307-284-3227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME103124
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberU9399
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: