Jennifer A Brady, RD

Individual provider Active NPI Registered Dietitian · Syracuse, UT

NPI 1093017485 · NPPES record last updated Nov 17, 2010

Key facts

NPI
1093017485
Entity type
Individual (NPI type 1)
Primary specialty
Registered Dietitian 133V00000X
License
5324848-4901 (UT)
Practice address
1966 S 2590 W
Syracuse, UT 84075-7022
Phone
(801) 698-3003
Fax
(801) 776-5252
NPI assigned
Nov 17, 2010
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
5324848-4901UTMDRegistered Dietitian

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 5324848-4901 UT Yes

Addresses

Primary practice location

1966 S 2590 W
Syracuse, UT 84075-7022

Mailing address

1966 S 2590 W
Syracuse, UT 84075-7022
Phone (801) 698-3003

Other providers in Syracuse, UT

All providers in Syracuse, UT · Registered Dietitian in Utah

Sources for this page

Verify at the official NPI Registry.