Healthcare Provider Details

I. General information

NPI: 1336052109
Provider Name (Legal Business Name): BRYNN AMELIA ZUNIGA RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 DOVER PL
CHAMPAIGN IL
61820-7032
US

IV. Provider business mailing address

718 DOVER PL
CHAMPAIGN IL
61820-7032
US

V. Phone/Fax

Practice location:
  • Phone: 847-567-9647
  • Fax:
Mailing address:
  • Phone: 847-567-9647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.025912
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: