Provider Demographics
NPI:1689065450
Name:SUMMERS, AMBER CHENELL (PHD, RD, CHES)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:CHENELL
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:PHD, RD, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 MAIN ST
Mailing Address - Street 2:APT. B
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4066
Mailing Address - Country:US
Mailing Address - Phone:843-697-3389
Mailing Address - Fax:
Practice Address - Street 1:647 MAIN ST
Practice Address - Street 2:APT. B
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4066
Practice Address - Country:US
Practice Address - Phone:843-697-3389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-14
Last Update Date:2015-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3572133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered