Provider Demographics
NPI:1174899017
Name:GUDAS, AMBER TARIO (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:TARIO
Last Name:GUDAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:BETHANY
Other - Last Name:TARIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3040 78TH AVE SE UNIT 958
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3685
Mailing Address - Country:US
Mailing Address - Phone:425-753-2918
Mailing Address - Fax:425-328-1288
Practice Address - Street 1:1414 116TH AVE NE STE E
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3801
Practice Address - Country:US
Practice Address - Phone:425-753-2918
Practice Address - Fax:425-328-1288
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60856995363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant