Provider Demographics
NPI:1700511771
Name:CEGLARZ, AMANDA RYAN (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:RYAN
Last Name:CEGLARZ
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 1:6633 CRABAPPLE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-1950
Mailing Address - Country:US
Mailing Address - Phone:248-763-3432
Mailing Address - Fax:
Practice Address - Street 1:2700 GALLATIN PIKE STE A
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37216-3702
Practice Address - Country:US
Practice Address - Phone:248-763-3432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4315133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered