Provider Demographics
NPI:1215520960
Name:AMIRY, NEDA (NP-C)
Entity type:Individual
Prefix:
First Name:NEDA
Middle Name:
Last Name:AMIRY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WAGON TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1240
Mailing Address - Country:US
Mailing Address - Phone:210-995-2039
Mailing Address - Fax:
Practice Address - Street 1:112 WAGON TRAIL RD
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1240
Practice Address - Country:US
Practice Address - Phone:210-995-2039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-13
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAPRN-CNP1033820363LG0600X
TXAGO1210002363LG0600X
TX832832163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology