Provider Demographics
NPI:1023733664
Name:CRENSHAW, AMYA
Entity type:Individual
Prefix:
First Name:AMYA
Middle Name:
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5749 PHEASANT CT
Mailing Address - Street 2:
Mailing Address - City:THEODORE
Mailing Address - State:AL
Mailing Address - Zip Code:36582-8860
Mailing Address - Country:US
Mailing Address - Phone:251-257-8396
Mailing Address - Fax:
Practice Address - Street 1:5749 PHEASANT CT
Practice Address - Street 2:
Practice Address - City:THEODORE
Practice Address - State:AL
Practice Address - Zip Code:36582-8860
Practice Address - Country:US
Practice Address - Phone:251-257-8396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program