Provider Demographics
NPI:1124284617
Name:JAFFE, AMY (MS,RD,LD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:JAFFE
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MAJORCA AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-448-8325
Mailing Address - Fax:305-448-0687
Practice Address - Street 1:111 MAJORCA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4508
Practice Address - Country:US
Practice Address - Phone:305-448-8325
Practice Address - Fax:305-448-0687
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 1329133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered