Provider Demographics
NPI:1982897179
Name:MILLER, AMY QUINN (RD, CDE, CDN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:QUINN
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD, CDE, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1631
Mailing Address - Country:US
Mailing Address - Phone:585-343-6030
Mailing Address - Fax:585-344-5267
Practice Address - Street 1:211 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2231
Practice Address - Country:US
Practice Address - Phone:585-344-5391
Practice Address - Fax:585-344-5267
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005712133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000527554001OtherBLUE CROSS BLUE SHIELD