Provider Demographics
NPI:1528802923
Name:PASKO, AMANDA (RDN, LDN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PASKO
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 LILLINGTON DR APT 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3635
Mailing Address - Country:US
Mailing Address - Phone:781-715-3409
Mailing Address - Fax:
Practice Address - Street 1:1616 EVANS RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-9653
Practice Address - Country:US
Practice Address - Phone:781-715-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007544133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered