Individual
AMANDA FRANCES DERYLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3001 BROADMOOR BLVD NE, RIO RANCHO, NM 87144-2100
(505) 994-7000
Mailing address
933 BRADBURY DR SE STE 2222, ALBUQUERQUE, NM 87106-4375
(505) 272-1111
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
66825
WI
2085R0202X
Diagnostic Radiology Physician
Primary
MD2017-0803
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760758064
—
WI
Enumeration date
03/30/2012
Last updated
06/16/2025
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