Provider Demographics
NPI:1699293241
Name:NEDD, AMANDA (RD, CD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:NEDD
Suffix:
Gender:
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 HARBOR BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5338
Mailing Address - Country:US
Mailing Address - Phone:941-625-4270
Mailing Address - Fax:
Practice Address - Street 1:2525 HARBOR BLVD STE 105
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5338
Practice Address - Country:US
Practice Address - Phone:941-625-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2571-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered