Provider Demographics
NPI:1508012626
Name:CHRENCIK, ELIZABETH WYMAN (MS, RD, LD/N)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:WYMAN
Last Name:CHRENCIK
Suffix:
Gender:F
Credentials:MS, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HIGHWAY A1A
Mailing Address - Street 2:#307
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2075
Mailing Address - Country:US
Mailing Address - Phone:321-434-7000
Mailing Address - Fax:
Practice Address - Street 1:1350 S HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:321-434-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL954367133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered