Healthcare Provider Details

I. General information

NPI: 1356597058
Provider Name (Legal Business Name): JUANITA M BRYANT R.D., CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SHERMAN POTTS DRIVE
GHENT NY
12075
US

IV. Provider business mailing address

6 HAMM RD
HUDSON NY
12534-4617
US

V. Phone/Fax

Practice location:
  • Phone: 518-929-0915
  • Fax:
Mailing address:
  • Phone: 518-929-0915
  • 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: