Active NPI
Amy Namsupak, DDS
- Pediatric Dentistry
- Virginia Beach, VA
National Provider Identifier
1811300460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 0401415277
- Practice address
- 2100 Lynnhaven Pkwy
Suite 200
Virginia Beach, VA 23456-1492 - Phone
- (757) 961-4000
- NPI assigned
- Jun 10, 2014
- Last updated
- Aug 3, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 0401415277 | VA | Primary |
Addresses
Primary practice location
2100 Lynnhaven Pkwy
Suite 200
Virginia Beach, VA 23456-1492
Mailing address
1537 Waltham Way
Apt 201
Chesapeake, VA 23320-4077
Phone (304) 993-1616
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401415277 | VA | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amyn, LLC | Pediatric Dentistry | Current | Accepting new patients |
Locations
2600 Taylor Rd
Chesapeake, VA 23321
Phone (757) 800-1011
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470182400000",
"number": "1811300460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1537 WALTHAM WAY",
"address_2": "APT 201",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233204077",
"telephone_number": "304-993-1616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 LYNNHAVEN PKWY",
"address_2": "SUITE 200",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234561492",
"telephone_number": "757-961-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAMSUPAK",
"first_name": "AMY",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-10",
"last_updated": "2016-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "VA",
"license": "0401415277",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.