Provider Demographics
NPI:1902931645
Name:MONROY, AMY (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:MONROY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 ENCINO PL NE
Mailing Address - Street 2:28
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2611
Mailing Address - Country:US
Mailing Address - Phone:505-338-4800
Mailing Address - Fax:505-338-4808
Practice Address - Street 1:717 ENCINO PL NE
Practice Address - Street 2:28
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2611
Practice Address - Country:US
Practice Address - Phone:505-338-4800
Practice Address - Fax:505-338-4808
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD0620133V00000X
NM0620133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM343713404Medicare PIN