Healthcare Provider Details

I. General information

NPI: 1467374447
Provider Name (Legal Business Name): AMY KUNZMAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 GARNER STATION BLVD
RALEIGH NC
27603-3644
US

IV. Provider business mailing address

1805 GARNER STATION BLVD
RALEIGH NC
27603-3644
US

V. Phone/Fax

Practice location:
  • Phone: 984-349-0820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL009713
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: