Healthcare Provider Details

I. General information

NPI: 1184540049
Provider Name (Legal Business Name): BROOKE SALLIT LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 SPRUCE ST
IRWIN PA
15642-3683
US

IV. Provider business mailing address

905 SPRUCE ST
IRWIN PA
15642-3683
US

V. Phone/Fax

Practice location:
  • Phone: 724-864-9595
  • Fax: 724-864-9860
Mailing address:
  • Phone: 724-864-9595
  • Fax: 724-864-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN006397
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: