Individual
AMANDA LYNN STATHOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LD
Contact information
Practice address
9031 ENDICOTT PL, LORTON, VA 22079-4541
(815) 321-1555
Mailing address
9031 ENDICOTT PL, LORTON, VA 22079-4541
(815) 321-1555
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI100001076
DC
133V00000X
Registered Dietitian
DX5408
MD
Other
Enumeration date
01/01/2020
Last updated
09/15/2022
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