Provider Demographics
NPI:1831532720
Name:SHORETTE, AMANDA SUE (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:SHORETTE
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 1:11900 N LA CANADA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-4001
Mailing Address - Country:US
Mailing Address - Phone:520-904-1936
Mailing Address - Fax:
Practice Address - Street 1:450 S OCOTILLO ST
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6490
Practice Address - Country:US
Practice Address - Phone:520-586-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA266224207P00000X
AZ55522207P00000X
CT056148207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine