Provider Demographics
NPI:1073276176
Name:FYOTEK, AMANDA HELEN (RD, LDN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:HELEN
Last Name:FYOTEK
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1001
Mailing Address - Country:US
Mailing Address - Phone:954-805-4042
Mailing Address - Fax:
Practice Address - Street 1:149 BEACH ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-1001
Practice Address - Country:US
Practice Address - Phone:954-805-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-16
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5377133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered