Provider Demographics
NPI:1144720434
Name:HAAR, AMANDA (RD, LD/N)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HAAR
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 SE 5TH CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-8938
Mailing Address - Country:US
Mailing Address - Phone:305-562-2176
Mailing Address - Fax:305-562-2176
Practice Address - Street 1:200 ADMIRALS COVE BLVD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4046
Practice Address - Country:US
Practice Address - Phone:561-745-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7198133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered