Healthcare Provider Details

I. General information

NPI: 1013554393
Provider Name (Legal Business Name): BRITTANY MARIE SNYDER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRITTANY MARIE AVERY RD

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 FREEDOM DR STE 7500
CHARLOTTE NC
28208-3490
US

IV. Provider business mailing address

7936 PARK RD
CHARLOTTE NC
28210-6728
US

V. Phone/Fax

Practice location:
  • Phone: 980-314-8517
  • Fax:
Mailing address:
  • Phone: 980-314-8517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL004072
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: