Provider Demographics
NPI:1659797876
Name:GOODWIN, AMANDA (MS RD LDN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1412
Mailing Address - Country:US
Mailing Address - Phone:856-452-1177
Mailing Address - Fax:
Practice Address - Street 1:811 CHURCH RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1412
Practice Address - Country:US
Practice Address - Phone:856-452-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1017270133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered