Healthcare Provider Details

I. General information

NPI: 1235352519
Provider Name (Legal Business Name): AMANDA LEE DESKINS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA LEE BANNISTER D.O.

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WHEELING AVE
GLEN DALE WV
26038-1697
US

IV. Provider business mailing address

32 CEDAR DR
HURRICANE WV
25526-9220
US

V. Phone/Fax

Practice location:
  • Phone: 304-845-3211
  • Fax: 304-843-3202
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2244
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: