Healthcare Provider Details

I. General information

NPI: 1629902911
Provider Name (Legal Business Name): PAYTON BREWER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 NE 1ST AVE APT 511
MIAMI FL
33137-5319
US

IV. Provider business mailing address

2901 NE 1ST AVE APT 511
MIAMI FL
33137-5319
US

V. Phone/Fax

Practice location:
  • Phone: 631-418-4656
  • Fax:
Mailing address:
  • Phone: 631-418-4656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: