MEDICARE: AMANDA MARIE LIPTAK RDN

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	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian	5319	OH

General Provider Information

NPI Number	:	1386360204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MARIE LIPTAK RDN

Provider Business Mailing Address
First Line	:	195 SOMERSET DR
Second Line	:
City	:	HINCKLEY
State	:	OH
Zip	:	44233-9655
Country	:	US
Telephone Number	:	330-441-1706
Fax Number	:

Provider Business Practice Location Address
First Line	:	5706 TURNEY RD STE 202
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-3928
Country	:	US
Telephone Number	:	330-441-1706
Fax Number	:

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

Provider Enumeration Date	:	10/12/2022
Last Update Date	:	09/24/2024

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