Provider Demographics
NPI:1760813786
Name:SABADA, KIMBERLY ANN (RD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:SABADA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 WASHINGTON ST UNIT 401
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-5322
Mailing Address - Country:US
Mailing Address - Phone:314-369-3159
Mailing Address - Fax:617-206-6133
Practice Address - Street 1:3305 WASHINGTON ST UNIT 401
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-5322
Practice Address - Country:US
Practice Address - Phone:314-369-3159
Practice Address - Fax:617-206-6133
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3500133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education