Provider Demographics
NPI:1033977756
Name:WYNNE, BRANDI (MS, CPT)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:WYNNE
Suffix:
Gender:F
Credentials:MS, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-7904
Mailing Address - Country:US
Mailing Address - Phone:240-675-1550
Mailing Address - Fax:
Practice Address - Street 1:205 BROAD ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-7904
Practice Address - Country:US
Practice Address - Phone:240-675-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education