Provider Demographics
NPI:1063049989
Name:FERNANDEZ, AMANDA MICHELE (DO)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 DOCTORS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-4502
Mailing Address - Country:US
Mailing Address - Phone:828-586-8971
Mailing Address - Fax:
Practice Address - Street 1:98 DOCTORS DR STE 200
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-4502
Practice Address - Country:US
Practice Address - Phone:828-586-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-02730207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine