Provider Demographics
NPI:1124306287
Name:SILEO, AMANDA JEWEL (DO)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JEWEL
Last Name:SILEO
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 1:1104 AUTUMN CREEK CT APT A
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63088-2422
Mailing Address - Country:US
Mailing Address - Phone:817-897-0496
Mailing Address - Fax:
Practice Address - Street 1:1502 W MEYER RD
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3653
Practice Address - Country:US
Practice Address - Phone:636-698-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-23
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011014918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine