Provider Demographics
NPI:1477654960
Name:BANKS, AMANDA (RD)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CASCADE LANE
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33404
Mailing Address - Country:US
Mailing Address - Phone:561-494-0564
Mailing Address - Fax:
Practice Address - Street 1:7305 N. MILITARY TRAIL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404
Practice Address - Country:US
Practice Address - Phone:561-422-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4160133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered