Healthcare Provider Details

I. General information

NPI: 1043744667
Provider Name (Legal Business Name): TANYA BROWN- SACCOH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 GREENTREE DR # 312
DOVER DE
19904-7646
US

IV. Provider business mailing address

73 GREENTREE DR # 312
DOVER DE
19904-7646
US

V. Phone/Fax

Practice location:
  • Phone: 302-510-3966
  • Fax:
Mailing address:
  • Phone: 302-510-3966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN005685
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: