MEDICARE: DR. AMANDA P STITELER M.D.

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208800000X	Urology Physician	0101264870	VA

General Provider Information

NPI Number	:	1679918700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA P STITELER M.D.

Provider Business Mailing Address
First Line	:	7703 FLOYD CURL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3901
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 KINGS WAY STE 3200
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-2511
Country	:	US
Telephone Number	:	757-253-0051
Fax Number	:	757-229-9526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2013
Last Update Date	:	08/15/2018

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