Provider Demographics
NPI:1073276176
Name:WILCOX, AMANDA HELEN (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:HELEN
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:HELEN
Other - Last Name:FYOTEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:11 HOOVER ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1518
Mailing Address - Country:US
Mailing Address - Phone:954-805-4042
Mailing Address - Fax:
Practice Address - Street 1:11 HOOVER ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-1518
Practice Address - Country:US
Practice Address - Phone:954-805-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-16
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5377133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered