Provider Demographics
NPI:1194876698
Name:PUNZO, AMALIA JANE (MD)
Entity type:Individual
Prefix:DR
First Name:AMALIA
Middle Name:JANE
Last Name:PUNZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:620 SAND LAKE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6084
Mailing Address - Country:US
Mailing Address - Phone:410-705-3582
Mailing Address - Fax:888-727-2212
Practice Address - Street 1:620 SAND LAKE CT
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6084
Practice Address - Country:US
Practice Address - Phone:410-705-3582
Practice Address - Fax:888-727-2212
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061215207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E56173Medicare UPIN