Provider Demographics
NPI:1679236061
Name:GERAGHTY, AMANDA RAE (RD)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:RAE
Last Name:GERAGHTY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 DELAWARE AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3590
Mailing Address - Country:US
Mailing Address - Phone:151-671-2523
Mailing Address - Fax:
Practice Address - Street 1:2005 DELAWARE AVE APT 1E
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-3590
Practice Address - Country:US
Practice Address - Phone:151-671-2523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86076263133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered