Provider Demographics
NPI:1447687710
Name:MATTHEWS, AMY ROSE (RD,LD)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ROSE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:ROSE
Other - Last Name:PAPONETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,LD,
Mailing Address - Street 1:215 MARSH HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-7549
Mailing Address - Country:US
Mailing Address - Phone:440-915-4632
Mailing Address - Fax:
Practice Address - Street 1:215 MARSH HAVEN DR
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460-7549
Practice Address - Country:US
Practice Address - Phone:440-915-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004195133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered