Provider Demographics
NPI:1417285826
Name:CUSICK, AMANDA D (RD LDN CDE)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:CUSICK
Suffix:
Gender:F
Credentials:RD LDN CDE
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:C
Other - Last Name:DEAKYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LDN CDE
Mailing Address - Street 1:740 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-3328
Mailing Address - Country:US
Mailing Address - Phone:724-983-7324
Mailing Address - Fax:724-932-5519
Practice Address - Street 1:32 JEFFERSON AVE STE 210
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3354
Practice Address - Country:US
Practice Address - Phone:724-983-7324
Practice Address - Fax:724-724-5519
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004266133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered