Provider Demographics
NPI:1811220734
Name:STRALEY, AMANDA MARIE (MS RD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:STRALEY
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 1:220 FORSGATE DR
Mailing Address - Street 2:
Mailing Address - City:JAMESBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1375
Mailing Address - Country:US
Mailing Address - Phone:732-966-0130
Mailing Address - Fax:732-656-1742
Practice Address - Street 1:220 FORSGATE DR
Practice Address - Street 2:
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831-1375
Practice Address - Country:US
Practice Address - Phone:732-966-0130
Practice Address - Fax:732-656-1742
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ948746133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered