Provider Demographics
NPI:1467852871
Name:BORRO, GEOFFREY (RD, CSSD, CSCS)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:BORRO
Suffix:
Gender:M
Credentials:RD, CSSD, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ISABELLE ISLE APT 202
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-5294
Mailing Address - Country:US
Mailing Address - Phone:443-223-6039
Mailing Address - Fax:
Practice Address - Street 1:300 TUSKEGEE BLVD BLDG 300
Practice Address - Street 2:
Practice Address - City:DOVER AIR FORCE BASE
Practice Address - State:DE
Practice Address - Zip Code:19902-5003
Practice Address - Country:US
Practice Address - Phone:302-677-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN-0000563133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered