Provider Demographics
NPI:1043697204
Name:AMIRNENI, AMULYA D (MD)
Entity type:Individual
Prefix:
First Name:AMULYA
Middle Name:D
Last Name:AMIRNENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17005 OLD ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4828
Mailing Address - Country:US
Mailing Address - Phone:302-703-4025
Mailing Address - Fax:
Practice Address - Street 1:17005 OLD ORCHARD RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4828
Practice Address - Country:US
Practice Address - Phone:302-703-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA276045207R00000X
DEC10024481207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine