Provider Demographics
NPI:1588819676
Name:BAKALAR, AMY R (MS RD)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:R
Last Name:BAKALAR
Suffix:
Gender:F
Credentials:MS RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ISLAND AVE
Mailing Address - Street 2:APT 305
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1347
Mailing Address - Country:US
Mailing Address - Phone:305-604-8492
Mailing Address - Fax:
Practice Address - Street 1:20 ISLAND AVE
Practice Address - Street 2:APT 305
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-1347
Practice Address - Country:US
Practice Address - Phone:305-604-8492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNCD0003030133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered