Provider Demographics
NPI:1972876217
Name:BRAY, DAYANA (RD, LD)
Entity Type:Individual
Prefix:
First Name:DAYANA
Middle Name:
Last Name:BRAY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1665
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22313-1665
Mailing Address - Country:US
Mailing Address - Phone:540-908-4584
Mailing Address - Fax:
Practice Address - Street 1:6010 ROCK CLIFF LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-4636
Practice Address - Country:US
Practice Address - Phone:540-908-4584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLDR893133N00000X
VA1002880133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist