Provider Demographics
NPI:1497373674
Name:BOMBAY, AMANDA CATHLEEN (RD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CATHLEEN
Last Name:BOMBAY
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 1:416 STRATFORD AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2211
Mailing Address - Country:US
Mailing Address - Phone:571-233-9954
Mailing Address - Fax:
Practice Address - Street 1:416 STRATFORD AVE
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108-2211
Practice Address - Country:US
Practice Address - Phone:571-233-9954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered