Provider Demographics
NPI:1558076307
Name:ESBENSHADE, BREANNA (RD,LD)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:ESBENSHADE
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 171235
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-0042
Mailing Address - Country:US
Mailing Address - Phone:512-338-4500
Mailing Address - Fax:
Practice Address - Street 1:5900 BALCONES DR STE 165
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4293
Practice Address - Country:US
Practice Address - Phone:512-338-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87566133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty