Provider Demographics
NPI:1598851305
Name:CRENSHAW, BRENDA SUSAN I (DIETITIAN)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:SUSAN
Last Name:CRENSHAW
Suffix:I
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3657 CARNFORTH DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-5265
Mailing Address - Country:US
Mailing Address - Phone:614-786-6362
Mailing Address - Fax:614-544-1711
Practice Address - Street 1:50 OLD VILLAGE ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1607
Practice Address - Country:US
Practice Address - Phone:614-566-8994
Practice Address - Fax:614-544-1711
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3183133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered