Provider Demographics
NPI:1700157419
Name:CONKLIN, AMANDA L (MS, RD, LDN, CNSC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:MS, RD, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 NEW BROAD CIR APT 113
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7359
Mailing Address - Country:US
Mailing Address - Phone:689-262-0597
Mailing Address - Fax:
Practice Address - Street 1:4001 NEW BROAD CIR APT 113
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7359
Practice Address - Country:US
Practice Address - Phone:689-262-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004677133V00000X
NCL006492133V00000X
FLND10545133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered