Provider Demographics
NPI:1407596919
Name:DAWSON, AMANDA C (MS, RD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:DAWSON
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 BALANCE MEETING RD
Mailing Address - Street 2:
Mailing Address - City:PEACH BOTTOM
Mailing Address - State:PA
Mailing Address - Zip Code:17563-9772
Mailing Address - Country:US
Mailing Address - Phone:856-237-9204
Mailing Address - Fax:
Practice Address - Street 1:229 BALANCE MEETING RD
Practice Address - Street 2:
Practice Address - City:PEACH BOTTOM
Practice Address - State:PA
Practice Address - Zip Code:17563-9772
Practice Address - Country:US
Practice Address - Phone:856-237-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86001876133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered