Provider Demographics
NPI:1154037547
Name:SAKR, AMANDA KELLY (RD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KELLY
Last Name:SAKR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 SE 10TH AVE APT 6133
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3185
Mailing Address - Country:US
Mailing Address - Phone:267-237-0893
Mailing Address - Fax:
Practice Address - Street 1:660 S BAGDAD RD STE 310
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-5049
Practice Address - Country:US
Practice Address - Phone:512-772-6788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86075552133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered