Provider Demographics
NPI:1588801252
Name:PECK, AMY GWEN (MS, RD, CPT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:GWEN
Last Name:PECK
Suffix:
Gender:F
Credentials:MS, RD, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 KATONAH AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2146
Mailing Address - Country:US
Mailing Address - Phone:914-232-1905
Mailing Address - Fax:
Practice Address - Street 1:223 KATONAH AVE
Practice Address - Street 2:SUITE F
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-2146
Practice Address - Country:US
Practice Address - Phone:914-232-1905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered