Provider Demographics
NPI:1437405461
Name:BRATHWAITE, PATRICIA JOLANDA (EDD MPH RD LDN)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JOLANDA
Last Name:BRATHWAITE
Suffix:
Gender:F
Credentials:EDD MPH RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 972371
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33197
Mailing Address - Country:US
Mailing Address - Phone:786-234-2184
Mailing Address - Fax:
Practice Address - Street 1:12267 SW 251ST TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5926
Practice Address - Country:US
Practice Address - Phone:786-234-2184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4594133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education