Provider Demographics
NPI:1801288584
Name:RONZO, AMANDA B (MS,RDN,CLC,CDN)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:B
Last Name:RONZO
Suffix:
Gender:F
Credentials:MS,RDN,CLC,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 MONROE AVE
Mailing Address - Street 2:STE 213
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4726
Mailing Address - Country:US
Mailing Address - Phone:585-563-9000
Mailing Address - Fax:585-301-4895
Practice Address - Street 1:3380 MONROE AVE
Practice Address - Street 2:STE 213
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4726
Practice Address - Country:US
Practice Address - Phone:585-563-9000
Practice Address - Fax:585-301-4895
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48006744133N00000X
NY00992733133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist