Provider Demographics
NPI:1043812100
Name:BERARDI, AMANDA LYNN (MS, RDN)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:LYNN
Last Name:BERARDI
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WENDOVER DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3328
Mailing Address - Country:US
Mailing Address - Phone:267-253-4411
Mailing Address - Fax:
Practice Address - Street 1:20 WENDOVER DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3328
Practice Address - Country:US
Practice Address - Phone:267-253-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86154110133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered