Healthcare Provider Details

I. General information

NPI: 1801288584
Provider Name (Legal Business Name): AMANDA B RONZO MS,RDN,CLC,CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 MONROE AVE STE 213
ROCHESTER NY
14618-4726
US

IV. Provider business mailing address

3380 MONROE AVE STE 213
ROCHESTER NY
14618-4726
US

V. Phone/Fax

Practice location:
  • Phone: 585-563-9000
  • Fax: 585-301-4895
Mailing address:
  • Phone: 585-563-9000
  • Fax: 585-301-4895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number48006744
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: