Provider Demographics
NPI:1437526936
Name:MATHEW, AMY LYNN (RD, LD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:MATHEW
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 CLEARPOINT CT
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-7686
Mailing Address - Country:US
Mailing Address - Phone:585-727-9905
Mailing Address - Fax:
Practice Address - Street 1:6500 GREENVILLE AVE STE 444
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1025
Practice Address - Country:US
Practice Address - Phone:972-265-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005720133V00000X
TXDT86987133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered