Healthcare Provider Details

I. General information

NPI: 1851912802
Provider Name (Legal Business Name): AMY LOUISE LEE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34709 9TH AVE S STE B500
FEDERAL WAY WA
98003-6789
US

IV. Provider business mailing address

34709 9TH AVE S STE B500
FEDERAL WAY WA
98003-6789
US

V. Phone/Fax

Practice location:
  • Phone: 860-449-4855
  • Fax:
Mailing address:
  • Phone: 860-449-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO.OP.70141806
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: