Provider Demographics
NPI:1275737835
Name:ELLIS, AMY ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELIZABETH
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 DOUGLAS BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4238
Mailing Address - Country:US
Mailing Address - Phone:916-755-6000
Mailing Address - Fax:
Practice Address - Street 1:3200 DOUGLAS BLVD STE 310
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4238
Practice Address - Country:US
Practice Address - Phone:916-755-6000
Practice Address - Fax:916-237-0285
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC1416782084P0800X, 208D00000X, 2083A0300X
CO485492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine