Provider Demographics
NPI:1942451893
Name:ERICKSON, BREANN SARA (RD)
Entity Type:Individual
Prefix:
First Name:BREANN
Middle Name:SARA
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:BREANN
Other - Middle Name:
Other - Last Name:FARNSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 TRAP FALLS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4616
Mailing Address - Country:US
Mailing Address - Phone:203-926-8835
Mailing Address - Fax:
Practice Address - Street 1:2 TRAP FALLS RD STE 100
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4616
Practice Address - Country:US
Practice Address - Phone:203-926-8835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00869133V00000X
CT869133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty