Healthcare Provider Details

I. General information

NPI: 1649784737
Provider Name (Legal Business Name): AMY LYNN WINSTEAD RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY LYNN COEN RD, LD

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 MARKET AVE N STE 100
CANTON OH
44721-2430
US

IV. Provider business mailing address

6545 MARKET AVE N STE 100
CANTON OH
44721-2430
US

V. Phone/Fax

Practice location:
  • Phone: 330-814-9355
  • Fax:
Mailing address:
  • Phone: 330-814-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number7664
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: