MEDICARE: AMY ELIZABETH PIECZARKA R.D., L.D.N

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	ND6145	FL
2	133N00000X	Nutritionist	ND6145	FL

General Provider Information

NPI Number	:	1417246661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ELIZABETH PIECZARKA R.D., L.D.N

Provider Business Mailing Address
First Line	:	1402 N O ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-1939
Country	:	US
Telephone Number	:	267-357-0054
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 N O ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-1939
Country	:	US
Telephone Number	:	267-357-0054
Fax Number	:

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

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	09/11/2015

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