Provider Demographics
NPI:1225825557
Name:DAHL, AMANDA (RDN, LD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DAHL
Suffix:
Gender:
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1764 S MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-9602
Mailing Address - Country:US
Mailing Address - Phone:601-260-7315
Mailing Address - Fax:
Practice Address - Street 1:1764 S MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-9602
Practice Address - Country:US
Practice Address - Phone:601-260-7315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD-1305133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered