Provider Demographics
NPI:1609655299
Name:BRYANT, SHAYNA (MPH, RDN, LD)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MPH, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 UTAH AVE
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:OH
Mailing Address - Zip Code:44437-1521
Mailing Address - Country:US
Mailing Address - Phone:330-261-4799
Mailing Address - Fax:
Practice Address - Street 1:4570 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-5352
Practice Address - Country:US
Practice Address - Phone:330-261-4799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH086152444133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered