Provider Demographics
NPI:1487869665
Name:BRUNICARDI, ARMANDA M (RD,LD)
Entity type:Individual
Prefix:
First Name:ARMANDA
Middle Name:M
Last Name:BRUNICARDI
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 STATE ROUTE 505
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-9773
Mailing Address - Country:US
Mailing Address - Phone:937-378-7892
Mailing Address - Fax:
Practice Address - Street 1:425 HOME ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-1407
Practice Address - Country:US
Practice Address - Phone:937-378-7892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3851133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered