Provider Demographics
NPI:1235965898
Name:LONGOLUCCO, AMANDA JOYCE (RD)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JOYCE
Last Name:LONGOLUCCO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:JOYCE
Other - Last Name:MCGINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:9 RICKY LN
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06365-8620
Mailing Address - Country:US
Mailing Address - Phone:860-215-5574
Mailing Address - Fax:
Practice Address - Street 1:66 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-5806
Practice Address - Country:US
Practice Address - Phone:860-934-4926
Practice Address - Fax:866-823-8168
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00935133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered