Provider Demographics
NPI:1518768605
Name:AMADASUN, THEA DANIELLE CARTOJANO (MD)
Entity type:Individual
Prefix:DR
First Name:THEA DANIELLE
Middle Name:CARTOJANO
Last Name:AMADASUN
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:THEA DANIELLE
Other - Middle Name:BANDOLON
Other - Last Name:CARTOJANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:19550 E 39TH ST S STE 335
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2311
Mailing Address - Country:US
Mailing Address - Phone:913-396-3807
Mailing Address - Fax:
Practice Address - Street 1:19550 E 39TH ST S STE 335
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2311
Practice Address - Country:US
Practice Address - Phone:913-396-3807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program