Provider Demographics
NPI:1851131700
Name:GROSSMAN, FABIENNE (RD, LD)
Entity type:Individual
Prefix:
First Name:FABIENNE
Middle Name:
Last Name:GROSSMAN
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 1:401 NW 70TH TER
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2239
Mailing Address - Country:US
Mailing Address - Phone:954-513-3530
Mailing Address - Fax:
Practice Address - Street 1:401 NW 70TH TER
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2239
Practice Address - Country:US
Practice Address - Phone:954-513-3530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000060171400000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty