Provider Demographics
NPI:1164086633
Name:YANEY, AMANDA ROACH (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ROACH
Last Name:YANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:DANIELLE
Other - Last Name:ROACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6100 PAN AMERICAN FREEWAY NE STE 200
Practice Address - Street 2:FAMILY MEDICINE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3401
Practice Address - Country:US
Practice Address - Phone:505-823-8282
Practice Address - Fax:505-823-8275
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2022-1203207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine