Healthcare Provider Details

I. General information

NPI: 1134757016
Provider Name (Legal Business Name): AMANDA DOS SANTOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 NE BLAKELY DR STE 2030
ISSAQUAH WA
98029-6201
US

IV. Provider business mailing address

751 NE BLAKELY DR
ISSAQUAH WA
98029-6201
US

V. Phone/Fax

Practice location:
  • Phone: 425-313-7080
  • Fax:
Mailing address:
  • Phone: 425-313-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA185156
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD61523027
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: