MEDICARE: AMANDA SPEARS 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	133V00000X	Registered Dietitian	LD.09842	OH
2	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1639905789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA SPEARS RDN

Provider Business Mailing Address
First Line	:	1221 HAYES AVE
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870-3345
Country	:	US
Telephone Number	:	440-935-7931
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 HAYES AVE
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870-3345
Country	:	US
Telephone Number	:	440-935-7931
Fax Number	:

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

Provider Enumeration Date	:	09/13/2024
Last Update Date	:	06/03/2026

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