Healthcare Provider Details

I. General information

NPI: 1760813786
Provider Name (Legal Business Name): KIMBERLY ANN SABADA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 WASHINGTON ST UNIT 401
JAMAICA PLAIN MA
02130-5322
US

IV. Provider business mailing address

3305 WASHINGTON ST UNIT 401
JAMAICA PLAIN MA
02130-5322
US

V. Phone/Fax

Practice location:
  • Phone: 314-369-3159
  • Fax: 617-206-6133
Mailing address:
  • Phone: 314-369-3159
  • Fax: 617-206-6133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number3500
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3500
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: