Provider Demographics
NPI:1891299095
Name:HOLLIDAY, AMANDA MATHIS (RD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MATHIS
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 CALEY WILSON RD
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-5476
Mailing Address - Country:US
Mailing Address - Phone:919-215-6752
Mailing Address - Fax:
Practice Address - Street 1:3128 SMOKETREE CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1014
Practice Address - Country:US
Practice Address - Phone:919-350-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002951133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered