Provider Demographics
NPI:1922616804
Name:BASHER, SOLLIE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:SOLLIE
Middle Name:
Last Name:BASHER
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 NE 2ND ST APT 222
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4365
Mailing Address - Country:US
Mailing Address - Phone:954-817-0000
Mailing Address - Fax:
Practice Address - Street 1:415 NE 2ND ST APT 222
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4365
Practice Address - Country:US
Practice Address - Phone:954-817-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9079133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered