Provider Demographics
NPI:1215767546
Name:STEWART, AMANDA LYNN (RDLD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:STEWART
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GRASS ST
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-6107
Mailing Address - Country:US
Mailing Address - Phone:513-515-8652
Mailing Address - Fax:
Practice Address - Street 1:7 GRASS ST
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-6107
Practice Address - Country:US
Practice Address - Phone:513-515-8652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5574133V00000X
FLND9764133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered