Provider Demographics
NPI:1427222140
Name:SHEWMAKER, AMANDA KAY (RDLD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:SHEWMAKER
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 VICTORIA LN STE 13
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3228
Mailing Address - Country:US
Mailing Address - Phone:956-412-6060
Mailing Address - Fax:956-412-6070
Practice Address - Street 1:512 VICTORIA LN STE 13
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3228
Practice Address - Country:US
Practice Address - Phone:956-412-6060
Practice Address - Fax:956-412-6070
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06832133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered