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General NPI Number Information
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NPI Number | 1033977756
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Entity Type | Individual
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Provider Name | BRANDI WYNNE MS, CNS, LDN, CPT
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Gender | Female
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 53 E PATRICK ST
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City | FREDERICK
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State | MD
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Zip | 21701-5673
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Country | US
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Telephone | 301-276-0413
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Fax | 240-771-0715
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Provider Business Mailing Address
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Address Line | 100 MIDDLETOWN PARKWARY UNIT 202
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City | MIDDLETOWN
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State | MD
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Zip | 21769-7904
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Country | US
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Telephone | 301-276-0413
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Fax | 240-771-0715
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | DX7061
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | DN008941
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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