Healthcare Provider Details

I. General information

NPI: 1386360204
Provider Name (Legal Business Name): AMANDA MARIE LIPTAK RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5706 TURNEY RD STE 202
GARFIELD HEIGHTS OH
44125-3928
US

IV. Provider business mailing address

195 SOMERSET DR
HINCKLEY OH
44233-9655
US

V. Phone/Fax

Practice location:
  • Phone: 330-441-1706
  • Fax:
Mailing address:
  • Phone: 330-441-1706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number5319
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: