Provider Demographics
NPI:1255688685
Name:DAVIDSON, AMELIA BETH (MS, RD, CSP, CD)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:BETH
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MS, RD, CSP, CD
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:BETH
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CSP, CD
Mailing Address - Street 1:100 MARIO CAPECCHI DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84113-1103
Mailing Address - Country:US
Mailing Address - Phone:801-662-5320
Mailing Address - Fax:801-662-5300
Practice Address - Street 1:100 MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-5320
Practice Address - Fax:801-662-5300
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6349146-4901133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric