Healthcare Provider Details

I. General information

NPI: 1457797961
Provider Name (Legal Business Name): AMANDA SARAH FREED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2671 NE 46TH ST
SEATTLE WA
98105-5041
US

IV. Provider business mailing address

1100 9TH AVE M4-PFS
SEATTLE WA
98101-2756
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-8000
  • Fax: 206-525-8070
Mailing address:
  • Phone: 206-515-5811
  • Fax: 206-341-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number60745494
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60745494
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60745494
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: