Provider Demographics
NPI:1659259364
Name:GIBBS, AMANDA MEE (MS RD CDN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MEE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MS RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:RAY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12977-0175
Mailing Address - Country:US
Mailing Address - Phone:315-406-6217
Mailing Address - Fax:
Practice Address - Street 1:133 PARK ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1244
Practice Address - Country:US
Practice Address - Phone:315-406-6217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86074426133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered