Provider Demographics
NPI:1770830069
Name:CHEEHAN, AMANDA (MS, RD, CDN, CDE)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CHEEHAN
Suffix:
Gender:F
Credentials:MS, RD, CDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 SHEPARD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1831
Mailing Address - Country:US
Mailing Address - Phone:716-200-9466
Mailing Address - Fax:
Practice Address - Street 1:408 SHEPARD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1831
Practice Address - Country:US
Practice Address - Phone:716-200-9466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007606-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered