Provider Demographics
NPI:1669887667
Name:AMATO, SALLYANNE (MS,RD,LD)
Entity type:Individual
Prefix:MRS
First Name:SALLYANNE
Middle Name:
Last Name:AMATO
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UNIVERSITY RDG
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3635
Mailing Address - Country:US
Mailing Address - Phone:864-372-3241
Mailing Address - Fax:864-282-3823
Practice Address - Street 1:200 UNIVERSITY RDG
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3635
Practice Address - Country:US
Practice Address - Phone:864-372-3241
Practice Address - Fax:864-282-3823
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC196133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576000286OtherSC DEPT OF HEALTH AND ENVIRONMENTAL CONTROL