Provider Demographics
NPI:1699531061
Name:BRODER, DANIELLE (MS, RD, CDN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BRODER
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3078 IRA RD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5217
Mailing Address - Country:US
Mailing Address - Phone:516-426-8224
Mailing Address - Fax:
Practice Address - Street 1:3078 IRA RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5217
Practice Address - Country:US
Practice Address - Phone:516-426-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86198363133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered