Provider Demographics
NPI:1992514863
Name:BRYSON, TAMMIE (RDN/LDN)
Entity type:Individual
Prefix:
First Name:TAMMIE
Middle Name:
Last Name:BRYSON
Suffix:
Gender:F
Credentials:RDN/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12507 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-1231
Mailing Address - Country:US
Mailing Address - Phone:814-490-4990
Mailing Address - Fax:
Practice Address - Street 1:12507 CEDAR DR
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-1231
Practice Address - Country:US
Practice Address - Phone:814-490-4990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002742133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered