Provider Demographics
NPI:1366427197
Name:SRODES, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SRODES
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 1:3000 STONEWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 STONEWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8317
Practice Address - Country:US
Practice Address - Phone:724-934-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426892208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7938736OtherAETNA
PA1754434OtherHIGHMARK BLUE SHIELD
PA410820OtherUPMC
PA13575OtherELDER HEALTH CARE
PA093998LMCMedicare ID - Type Unspecified
I39503Medicare UPIN