Provider Demographics
NPI:1841863024
Name:BROWN SUGAR NUTRITION PLLC
Entity type:Organization
Organization Name:BROWN SUGAR NUTRITION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:IMASHI
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:406-580-4930
Mailing Address - Street 1:13725 32ND AVE NE APT B224
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-3694
Mailing Address - Country:US
Mailing Address - Phone:406-580-4930
Mailing Address - Fax:
Practice Address - Street 1:13725 32ND AVE NE APT B224
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-3694
Practice Address - Country:US
Practice Address - Phone:406-580-4930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty