Healthcare Provider Details

I. General information

NPI: 1851131700
Provider Name (Legal Business Name): FABIENNE GROSSMAN RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NW 70TH TER
PLANTATION FL
33317-2239
US

IV. Provider business mailing address

401 NW 70TH TER
PLANTATION FL
33317-2239
US

V. Phone/Fax

Practice location:
  • Phone: 954-513-3530
  • Fax:
Mailing address:
  • Phone: 954-513-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number000060
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000060
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: