Provider Demographics
NPI:1417580614
Name:WOODMAN, AMY G (RDN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:G
Last Name:WOODMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SILVER BROOK LANE
Mailing Address - Street 2:
Mailing Address - City:NORTH GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06060-1111
Mailing Address - Country:US
Mailing Address - Phone:860-324-8963
Mailing Address - Fax:
Practice Address - Street 1:1 SILVER BROOK LN
Practice Address - Street 2:
Practice Address - City:NORTH GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06060-1111
Practice Address - Country:US
Practice Address - Phone:860-324-8963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-16
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered