Provider Demographics
NPI:1740179076
Name:MULLANE, AMANDA KATE (MS, RD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATE
Last Name:MULLANE
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 1:5 OLDE FLATBROOK RD
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1607
Mailing Address - Country:US
Mailing Address - Phone:860-334-8902
Mailing Address - Fax:860-837-5269
Practice Address - Street 1:11 SOUTH RD STE 120
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2483
Practice Address - Country:US
Practice Address - Phone:860-334-8902
Practice Address - Fax:860-334-8902
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001929133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty