Provider Demographics
NPI:1679982656
Name:BUXBAUM, AMANDA (MS, CNS, LDN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BUXBAUM
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8632 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6704
Mailing Address - Country:US
Mailing Address - Phone:301-943-6952
Mailing Address - Fax:
Practice Address - Street 1:8632 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-6704
Practice Address - Country:US
Practice Address - Phone:301-943-6952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3296133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education