Healthcare Provider Details

I. General information

NPI: 1659276780
Provider Name (Legal Business Name): AMANDA B SLUSS RN, NTP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 ELMHURST AVE
ROYAL OAK MI
48073-3016
US

IV. Provider business mailing address

3125 ELMHURST AVE
ROYAL OAK MI
48073-3016
US

V. Phone/Fax

Practice location:
  • Phone: 248-303-1314
  • Fax:
Mailing address:
  • Phone: 248-303-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4704262442
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: