Healthcare Provider Details

I. General information

NPI: 1679089502
Provider Name (Legal Business Name): BRENDA FIKRY MS,RD,LD,EP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3862 CENTRAL AVE STE A
SAINT PETERSBURG FL
33711-1202
US

IV. Provider business mailing address

642 11TH AVE S
SAINT PETERSBURG FL
33701-5107
US

V. Phone/Fax

Practice location:
  • Phone: 727-344-9933
  • Fax:
Mailing address:
  • Phone: 315-525-8784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: