Provider Demographics
NPI:1629548078
Name:RIGBY, AMANDA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:RIGBY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 KENYON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4213
Mailing Address - Country:US
Mailing Address - Phone:401-533-4934
Mailing Address - Fax:
Practice Address - Street 1:373 NEW BOSTON RD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5814
Practice Address - Country:US
Practice Address - Phone:508-245-9415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00922133V00000X
MA4508133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1417125717Medicaid