Provider Demographics
NPI:1093415135
Name:REICHARDT, AMANDA JACQUELINE (MS RDN CDN CPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JACQUELINE
Last Name:REICHARDT
Suffix:
Gender:F
Credentials:MS RDN CDN CPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JACQUELINE
Other - Last Name:REICHARDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS RDN CDN CPT
Mailing Address - Street 1:41 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2932
Mailing Address - Country:US
Mailing Address - Phone:631-204-3375
Mailing Address - Fax:
Practice Address - Street 1:41 JOHN ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2932
Practice Address - Country:US
Practice Address - Phone:631-205-3375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86050604133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered