Provider Demographics
NPI:1790256196
Name:HENDEL, AMANDA (RD, LDN, CNSC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HENDEL
Suffix:
Gender:F
Credentials:RD, LDN, CNSC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:BREMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:636 JAMESTOWN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1705
Mailing Address - Country:US
Mailing Address - Phone:215-694-7716
Mailing Address - Fax:
Practice Address - Street 1:417 WINDOVER RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-3937
Practice Address - Country:US
Practice Address - Phone:215-694-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006594133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered