Provider Demographics
NPI:1730362112
Name:SERGAY, AMANDA BROOKE (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BROOKE
Last Name:SERGAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 W AZEELE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3018
Mailing Address - Country:US
Mailing Address - Phone:917-309-3019
Mailing Address - Fax:813-738-5661
Practice Address - Street 1:3216 W AZEELE ST STE 1
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3018
Practice Address - Country:US
Practice Address - Phone:813-738-5660
Practice Address - Fax:813-738-5661
Is Sole Proprietor?:No
Enumeration Date:2007-12-09
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114062207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology