Provider Demographics
NPI:1386480499
Name:KUENNEN, AUSTIN REID (RDN)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:REID
Last Name:KUENNEN
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-3013
Mailing Address - Country:US
Mailing Address - Phone:636-579-1255
Mailing Address - Fax:
Practice Address - Street 1:410 N CATTLEMEN RD APT 103
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6494
Practice Address - Country:US
Practice Address - Phone:636-579-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13160133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered