Provider Demographics
NPI:1407349376
Name:ROBINSON, AMANDA HEATHER (DAOM)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:HEATHER
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:DAOM
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:HEATHER
Other - Last Name:RASNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-2111
Mailing Address - Country:US
Mailing Address - Phone:401-595-1814
Mailing Address - Fax:
Practice Address - Street 1:208 GOVERNOR ST FL 1
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3246
Practice Address - Country:US
Practice Address - Phone:401-595-1814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00480171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist