Provider Demographics
NPI:1962094359
Name:PICKETT, AMANDA E (MS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:PICKETT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 OLD GUNPOWDER RD
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1137
Mailing Address - Country:US
Mailing Address - Phone:301-655-6373
Mailing Address - Fax:
Practice Address - Street 1:11800 OLD GUNPOWDER RD
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-1137
Practice Address - Country:US
Practice Address - Phone:301-655-6373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist