Provider Demographics
NPI:1760279954
Name:GREENWOOD, AMELIA DE-WAN
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:DE-WAN
Last Name:GREENWOOD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-1813
Mailing Address - Country:US
Mailing Address - Phone:937-212-4177
Mailing Address - Fax:
Practice Address - Street 1:8760 DEER PLAINS WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-7019
Practice Address - Country:US
Practice Address - Phone:937-212-4177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program