Provider Demographics
NPI:1639260730
Name:BRANDL, SHARON ELIZABETH (RD)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ELIZABETH
Last Name:BRANDL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 BIRKS LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5826
Mailing Address - Country:US
Mailing Address - Phone:757-408-8345
Mailing Address - Fax:757-382-7572
Practice Address - Street 1:745 BATTLEFIELD BLVD N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0305
Practice Address - Country:US
Practice Address - Phone:757-408-8345
Practice Address - Fax:757-382-7572
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
805568133V00000X
NCL001905133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8945292Medicaid
VA710000020Medicare ID - Type Unspecified
VA8945292Medicaid