Provider Demographics
NPI:1912744251
Name:ELLERBROOK, AISLINN J (RD)
Entity type:Individual
Prefix:
First Name:AISLINN
Middle Name:J
Last Name:ELLERBROOK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N CONGRESS AVE APT 27
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2964
Mailing Address - Country:US
Mailing Address - Phone:201-673-2605
Mailing Address - Fax:
Practice Address - Street 1:1167 W BALTIMORE PIKE STE 225
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5121
Practice Address - Country:US
Practice Address - Phone:724-407-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND10289133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered