Inna Aurelia Amaryllis, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

R82087 Issued in AZ

Practice address

2920 N 4TH St
Flagstaff, AZ 86004-1816

Phone

(928) 522-9400

NPI assigned

Jul 19, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1721347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751932800000",
    "number": "1316785652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2814 E 65TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462202225",
            "telephone_number": "574-221-9828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 N 4TH ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041816",
            "telephone_number": "928-522-9400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2814 E 65th St",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462202225",
            "country_code": "US",
            "telephone_number": "574-221-9828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AMARYLLIS",
        "first_name": "INNA",
        "middle_name": "AURELIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-19",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "AZ",
            "license": "R82087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Student in an Organized Health Care Education/Training Program in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Student in an Organized Health Care Education/Training Program in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2025; 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.