Provider Demographics
NPI:1194905372
Name:CUMBERLEDGE, AMANDA GRACE (RD, LD, CNSD)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:GRACE
Last Name:CUMBERLEDGE
Suffix:
Gender:F
Credentials:RD, LD, CNSD
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:GRACE
Other - Last Name:NARANJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:800 W RANDOL MILL RD
Mailing Address - Street 2:CLINICAL NUTRITION
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2504
Mailing Address - Country:US
Mailing Address - Phone:817-548-6190
Mailing Address - Fax:
Practice Address - Street 1:800 W RANDOL MILL RD
Practice Address - Street 2:CLINICAL NUTRITION
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2504
Practice Address - Country:US
Practice Address - Phone:817-548-6190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07132133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT07132OtherLICENSED DIETITIAN
TX917942OtherREGISTERED DIETITIAN