MEDICARE: BRANDEANA SANTERA MARIE BREDEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD.09174	OH

General Provider Information

NPI Number	:	1982559407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDEANA SANTERA MARIE BREDEN

Provider Business Mailing Address
First Line	:	45 BEVERLY PL
Second Line	:
City	:	OAKWOOD
State	:	OH
Zip	:	45419-3402
Country	:	US
Telephone Number	:	618-593-2265
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 BEVERLY PL
Second Line	:
City	:	OAKWOOD
State	:	OH
Zip	:	45419-3402
Country	:	US
Telephone Number	:	618-593-2265
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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