Provider Demographics
NPI:1902687361
Name:BRANDY WINFREE, RDN, LLC
Entity Type:Organization
Organization Name:BRANDY WINFREE, RDN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RENAL DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WINFREE
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CSR, LDN
Authorized Official - Phone:318-210-6429
Mailing Address - Street 1:410 EMERALD POINTE DR
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-2767
Mailing Address - Country:US
Mailing Address - Phone:318-210-6429
Mailing Address - Fax:
Practice Address - Street 1:410 EMERALD POINTE DR
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-2767
Practice Address - Country:US
Practice Address - Phone:318-210-6429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty