Provider Demographics
NPI:1134819790
Name:BROOKS, PENNY SABRINA (MS, RD, LD/N)
Entity type:Individual
Prefix:MS
First Name:PENNY
Middle Name:SABRINA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MS, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 LAKECREST DR APT 803
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3332
Mailing Address - Country:US
Mailing Address - Phone:305-989-1745
Mailing Address - Fax:
Practice Address - Street 1:7500 HANOVER PKWY STE 105A
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2011
Practice Address - Country:US
Practice Address - Phone:301-220-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4497133N00000X, 133NN1002X
FL86020556133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education