MEDICARE: AMANDA BIANCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86030901	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C09633	OTHER	VA	GROUP PTAN

General Provider Information

NPI Number	:	1346602372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA BIANCO

Provider Business Mailing Address
First Line	:	413 STUART CIR UNIT 210
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-3754
Country	:	US
Telephone Number	:	804-593-3103
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 STUART CIR UNIT 210
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-3754
Country	:	US
Telephone Number	:	804-593-3103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	08/18/2016

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Directions to “ AMANDA BIANCO ” Practice Location

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