Provider Demographics
NPI:1881832616
Name:JAFRI, BRYN E (LN, ACSM-HFS)
Entity Type:Individual
Prefix:
First Name:BRYN
Middle Name:E
Last Name:JAFRI
Suffix:
Gender:M
Credentials:LN, ACSM-HFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11121 MANTEO CT
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-9135
Mailing Address - Country:US
Mailing Address - Phone:571-251-7635
Mailing Address - Fax:
Practice Address - Street 1:11121 MANTEO CT
Practice Address - Street 2:
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040-9135
Practice Address - Country:US
Practice Address - Phone:571-251-7635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNU100000130133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist