Individual
BRAEDYN WESLEY MALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDN, LDN
Contact information
Practice address
2905 UNIVERSITY DR, DURHAM, NC 27707-3854
(919) 274-6166
Mailing address
2905 UNIVERSITY DR, DURHAM, NC 27707-3854
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
L005687
NC
Other
Enumeration date
09/09/2020
Last updated
09/09/2020
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