Provider Demographics
NPI:1356927396
Name:WELLS, AMY ELIZABETH
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 CONESTOGA RD STE 106
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1352
Mailing Address - Country:US
Mailing Address - Phone:610-525-5028
Mailing Address - Fax:
Practice Address - Street 1:919 CONESTOGA RD STE 106
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1352
Practice Address - Country:US
Practice Address - Phone:610-525-5028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD490225207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology