Healthcare Provider Details

I. General information

NPI: 1558022384
Provider Name (Legal Business Name): ANDREA BRYAN MS, RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 N BROAD ST
NORWICH NY
13815-1019
US

IV. Provider business mailing address

488 KING RD
GREENE NY
13778-3238
US

V. Phone/Fax

Practice location:
  • Phone: 607-337-4812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: