Healthcare Provider Details

I. General information

NPI: 1477240133
Provider Name (Legal Business Name): AMANDA JO DOWNEY MPH, RDN, LD/N, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA JO WILCOX

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N WACKER DR UNIT 201
CHICAGO IL
60606-1633
US

IV. Provider business mailing address

1124 SW 45TH TER
CAPE CORAL FL
33914-6341
US

V. Phone/Fax

Practice location:
  • Phone: 239-255-6755
  • Fax:
Mailing address:
  • Phone: 402-432-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND11458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: