Provider Demographics
NPI:1386259786
Name:PANTONE, AMANDA JO (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JO
Last Name:PANTONE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:JO
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7240 SHADELAND STA STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3968
Practice Address - Country:US
Practice Address - Phone:317-621-2677
Practice Address - Fax:317-621-2676
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN133V00000X
IN37003068A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered