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Individual

AMANDA M SUSTAITA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
12221 MERIT DR, STE. 1600, DALLAS, TX 75251-2202
(214) 217-1935
(214) 217-1956
Mailing address
12221 MERIT DR, STE. 1600, DALLAS, TX 75251-2202
(214) 217-1935
(214) 217-1956

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
730895
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
299980701
TX
05
299980702
TX
Enumeration date
03/31/2012
Last updated
10/23/2012
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