Individual
AMANDA E AVELLONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1455 US HIGHWAY 61, FESTUS, MO 63028-4157
(636) 937-3121
(636) 937-4423
Mailing address
1455 US HIGHWAY 61, FESTUS, MO 63028-4157
(636) 937-3121
(636) 937-4423
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
2004030200
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207306903
—
MO
01
—
P00229439
MEDICARE RAILROAD
MO
Enumeration date
06/09/2005
Last updated
07/30/2024
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