Provider Demographics
NPI:1568219632
Name:SCOTT, AMANDA (ND, LDN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:ND, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 CENTREPARK BLVD APT 509
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-7461
Mailing Address - Country:US
Mailing Address - Phone:561-512-8420
Mailing Address - Fax:
Practice Address - Street 1:8348 LEMONT RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-1510
Practice Address - Country:US
Practice Address - Phone:630-442-0169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.011089133N00000X
FLND14021133N00000X
MAND10024175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133N00000XDietary & Nutritional Service ProvidersNutritionist