Provider Demographics
NPI:1679089502
Name:FIKRY, BRENDA (MS,RD,LD,EP-C)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:FIKRY
Suffix:
Gender:F
Credentials:MS,RD,LD,EP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-5107
Mailing Address - Country:US
Mailing Address - Phone:315-525-8784
Mailing Address - Fax:
Practice Address - Street 1:3862 CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1202
Practice Address - Country:US
Practice Address - Phone:727-344-9933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic