Provider Demographics
NPI:1336921410
Name:BROWN, BRACHA (RD)
Entity Type:Individual
Prefix:
First Name:BRACHA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:BRACHA
Other - Middle Name:
Other - Last Name:MOSESSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:18024 CARROLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-6330
Mailing Address - Country:US
Mailing Address - Phone:516-784-9271
Mailing Address - Fax:
Practice Address - Street 1:18024 CARROLLWOOD DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-6330
Practice Address - Country:US
Practice Address - Phone:516-784-9271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87388133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered