Provider Demographics
NPI:1780056911
Name:BREWER-SORENDO, TAMMY JEAN (RD, LDN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:BREWER-SORENDO
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 BURGOYNE CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-3566
Mailing Address - Country:US
Mailing Address - Phone:336-708-1645
Mailing Address - Fax:
Practice Address - Street 1:1961 BURGOYNE CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-3566
Practice Address - Country:US
Practice Address - Phone:336-708-1645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC848513133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered