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General NPI Number Information
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NPI Number | 1649602863
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Entity Type | Individual
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Provider Name | AMANDA J. FERNANDES MD
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Gender | Female
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Dates
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Enumeration Date | 07/30/2013
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 375 WAMPANOAG TRL
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City | RIVERSIDE
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State | RI
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Zip | 02915
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Country | US
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Telephone | 401-649-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 110 ELM ST FL 2
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City | PROVIDENCE
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State | RI
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Zip | 02903-4626
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Country | US
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Telephone | 401-443-4992
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MD16760
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License Number State | RI
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