Amanda Lynne Fagan, D.O

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS17191 Issued in FL

Practice address

4613 S Orange Blossom TRL
Orlando, FL 32839-1705

Phone

(407) 232-9833

Fax

(407) 232-9829

NPI assigned

May 4, 2015

Last updated

Feb 3, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Amanda Lynne Stuck Former name

Medicare fee-for-service enrollment

Enrolled in NV, FL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dedicated Senior Medical Center of Florida, LLC

  • Specialist
  • Miami Gardens, FL
  • NPI 1881055366
  Medicare reassignment NPD
• Optum Medical Group II Rhodes P C

  dba Southwest Medical

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1790329407
  Medicare reassignment NPD
• Southwest Medical Associates, Inc

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1659346005
  Medicare reassignment NPD
• Dedicated Senior Medical Center of Florida, LLC

  • Specialist
  • Jacksonville, FL
  • NPI 1346757432
  NPD
• Dedicated Senior Medical Center of Florida, LLC

  • Specialist
  • Tampa, FL
  • NPI 1700393881
  NPD
• Optum Medical Group Rhodes P C

  dba Optumcare Anesthesia

  • Anesthesiology Physician
  • Las Vegas, NV
  • NPI 1770556037
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1245617802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4613 S ORANGE BLOSSOM TRL",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328391705",
            "telephone_number": "407-232-9833",
            "fax_number": "407-232-9829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4613 S ORANGE BLOSSOM TRL",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328391705",
            "telephone_number": "407-232-9833",
            "fax_number": "407-232-9829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "AMANDA",
        "middle_name": "LYNNE",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-04",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "DO2319",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "SL1068",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS17191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "STUCK",
            "middle_name": "LYNNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shantana Janae Fadeyi, R.PH
• Fadi Assaf DDS III PLLC
• Vanessa Fadul, ARNP
• Melissa Faenza
• Brooke Faer, LMHC
• Heather Ann Fagan, MD
• Ohna Fagan, LCSW, LCADC
• Suellen Fagin-Allen, L.M.H.C.
• Stacey L Fague, CRNP
• Doreen M Fahey, D.D.S

• Family Medicine Physician in Orlando, FL
• Providers in Orlando, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.