Provider Demographics
NPI:1669267340
Name:ABRAHAM, AMANDA (MS, CHN)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MS, CHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1406
Mailing Address - Country:US
Mailing Address - Phone:310-733-6541
Mailing Address - Fax:
Practice Address - Street 1:1422 6TH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1406
Practice Address - Country:US
Practice Address - Phone:510-519-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139795330133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist