Healthcare Provider Details

I. General information

NPI: 1942622212
Provider Name (Legal Business Name): ANTHONY AMATO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO RD SUITE 100
RICHMOND VA
23226-1930
US

IV. Provider business mailing address

6534 HANOVER AVE
RICHMOND VA
23226-3006
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-8127
  • Fax:
Mailing address:
  • Phone: 919-561-0329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0001239159
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024171435
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: