Provider Demographics
NPI:1659961365
Name:LEE, AMY (MS RDN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MS RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 GUYANOGA RD
Mailing Address - Street 2:
Mailing Address - City:BRANCHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14418-9501
Mailing Address - Country:US
Mailing Address - Phone:315-224-1695
Mailing Address - Fax:
Practice Address - Street 1:3400 GUYANOGA RD
Practice Address - Street 2:
Practice Address - City:BRANCHPORT
Practice Address - State:NY
Practice Address - Zip Code:14418-9501
Practice Address - Country:US
Practice Address - Phone:315-224-1695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management