Provider Demographics
NPI:1386360204
Name:LIPTAK, AMANDA MARIE (RDN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:LIPTAK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9655
Mailing Address - Country:US
Mailing Address - Phone:330-441-1706
Mailing Address - Fax:
Practice Address - Street 1:5706 TURNEY RD STE 202
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3928
Practice Address - Country:US
Practice Address - Phone:330-441-1706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5319133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management