Provider Demographics
NPI:1760506208
Name:RENDELMAN, BRENDA B (RD, LD, CDE)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:B
Last Name:RENDELMAN
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 W MOUND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-1855
Mailing Address - Country:US
Mailing Address - Phone:614-437-2876
Mailing Address - Fax:614-278-3143
Practice Address - Street 1:1699 W MOUND ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-1855
Practice Address - Country:US
Practice Address - Phone:614-437-2876
Practice Address - Fax:614-278-3143
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH535978133V00000X, 133V00000X
OHLD1667133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0155704Medicaid