Provider Demographics
NPI:1881661155
Name:BREEN, TERESA M (RD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:BREEN
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 1:415 RAY C HUNT DR STE 2100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-2980
Mailing Address - Country:US
Mailing Address - Phone:434-243-4620
Mailing Address - Fax:434-243-4619
Practice Address - Street 1:1840 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-8000
Practice Address - Fax:540-536-7681
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA002696W68Medicare PIN
P98563Medicare UPIN