Provider Demographics
NPI:1881468528
Name:BROBECK, SARA (RDN/LDN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BROBECK
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 1:130 W GRAND AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-6641
Mailing Address - Country:US
Mailing Address - Phone:917-952-8827
Mailing Address - Fax:
Practice Address - Street 1:130 W GRAND AVE APT 101
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-6641
Practice Address - Country:US
Practice Address - Phone:917-952-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86111754133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered