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NPI Code Detail

MEDICARE: AMANDA JOY WHEELER

MEDICARE: AMANDA JOY WHEELER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363A00000XPhysician Assistant0110007700VA

General Provider Information

NPI Number : 1407480460
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA JOY WHEELER
Provider Business Mailing Address
First Line : 3626 BELLE AVE NE
Second Line :
City : ROANOKE
State : VA
Zip : 24012-6408
Country : US
Telephone Number : 540-968-3030
Fax Number :
Provider Business Practice Location Address
First Line : 3626 BELLE AVE NE
Second Line :
City : ROANOKE
State : VA
Zip : 24012-6408
Country : US
Telephone Number : 540-968-3030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2020
Last Update Date : 08/26/2025

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