Provider Demographics
NPI:1205026119
Name:MORAN, AMY (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:MORAN
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 1:615 WOODCREST AVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1919
Mailing Address - Country:US
Mailing Address - Phone:610-329-5326
Mailing Address - Fax:
Practice Address - Street 1:615 WOODCREST AVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-1919
Practice Address - Country:US
Practice Address - Phone:610-329-5326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered