Provider Demographics
NPI:1760126627
Name:WOOLNOUGH, AMANDA LYN (RDN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYN
Last Name:WOOLNOUGH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYN
Other - Last Name:SHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:335 MOULTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2035
Mailing Address - Country:US
Mailing Address - Phone:315-222-8896
Mailing Address - Fax:
Practice Address - Street 1:415 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3920
Practice Address - Country:US
Practice Address - Phone:315-221-4881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered