Provider Demographics
NPI:1306711361
Name:YATES, BRENDA (RD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:YATES
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 1:4 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:10505-2023
Mailing Address - Country:US
Mailing Address - Phone:914-522-6607
Mailing Address - Fax:646-619-4600
Practice Address - Street 1:4 VISTA DR
Practice Address - Street 2:
Practice Address - City:BALDWIN PLACE
Practice Address - State:NY
Practice Address - Zip Code:10505-2023
Practice Address - Country:US
Practice Address - Phone:914-522-6607
Practice Address - Fax:646-619-4600
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered