Provider Demographics
NPI:1073860714
Name:SPRAGUE, AMANDA GAIL (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:GAIL
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:GAIL
Other - Last Name:STRAUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:603 N WASHINGTON AVE
Mailing Address - Street 2:DIABETES EDUCATION
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2107
Mailing Address - Country:US
Mailing Address - Phone:321-268-6699
Mailing Address - Fax:
Practice Address - Street 1:603 N WASHINGTON AVE
Practice Address - Street 2:DIABETES EDUCATION
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2107
Practice Address - Country:US
Practice Address - Phone:321-268-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 6309133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered