Individual
MRS. AMANDA J MONTALVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
226 WOODLAND DR, RAEFORD, NC 28376-5410
(860) 424-6962
Mailing address
226 WOODLAND DR, RAEFORD, NC 28376-5410
(860) 424-6962
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86011975
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86011975
N/A
—
Enumeration date
06/19/2019
Last updated
10/20/2021
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