Healthcare Provider Details

I. General information

NPI: 1255688685
Provider Name (Legal Business Name): AMELIA BETH DAVIDSON MS, RD, CSP, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMELIA BETH MCBRIDE MS, RD, CSP, CD

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

100 MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-5320
  • Fax: 801-662-5300
Mailing address:
  • Phone: 801-662-5320
  • Fax: 801-662-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number6349146-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: