Provider Demographics
NPI:1871851972
Name:GOODWIN, AMY LESHER (PA-C)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:LESHER
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:LYN
Other - Last Name:LESHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1332 W RITNER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-3537
Mailing Address - Country:US
Mailing Address - Phone:267-319-1939
Mailing Address - Fax:
Practice Address - Street 1:1332 W RITNER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3537
Practice Address - Country:US
Practice Address - Phone:267-319-1939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055364363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical