Active NPI
Amy Elizabeth Nedley, PA-C
- Pediatric Dentistry
- Toledo, OH
National Provider Identifier
1508845728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 2901016874
- Practice address
- 3125 Transverse Dr
Toledo, OH 43614-8008 - Phone
- (419) 383-3780
- Fax
- (419) 383-2023
- NPI assigned
- Jan 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 50.005039RX | OH | |
| Pediatric Dentistry | 1223P0221X | 2901016874 | MI | Primary |
Addresses
Primary practice location
3125 Transverse Dr
Toledo, OH 43614-8008
Mailing address
3355 Glendale Ave FL 3
Toledo, OH 43614-2426
Phone (419) 383-5322
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3244055 | Medicaid | MI | |
| J801645 | Other | MI | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901016874 | MI | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507161600000",
"number": "1508845728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3355 GLENDALE AVE FL 3",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436142426",
"telephone_number": "419-383-5322",
"fax_number": "419-383-6235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3125 TRANSVERSE DR",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436148008",
"telephone_number": "419-383-3780",
"fax_number": "419-383-2023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEDLEY",
"first_name": "AMY",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-16",
"last_updated": "2017-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OH",
"license": "50.005039RX",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MI",
"license": "2901016874",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3244055",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "J801645",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Toledo, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.