Healthcare Provider Details

I. General information

NPI: 1548173578
Provider Name (Legal Business Name): AMY DANIELS NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8494 BRUTUS CT
SPRINGFIELD VA
22153-4006
US

IV. Provider business mailing address

8494 BRUTUS CT
SPRINGFIELD VA
22153-4006
US

V. Phone/Fax

Practice location:
  • Phone: 571-214-9176
  • Fax: 703-261-8276
Mailing address:
  • Phone: 571-214-9176
  • Fax: 703-261-8276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY BETH DANIELS
Title or Position: OWNER
Credential: MS, RDN
Phone: 571-214-9176