Sandra A Ambrose, NUTRITIONIST

Primary specialty

Nutrition Education NutritionistTaxonomy code 133NN1002X

License

1312 Issued in MA

Practice address

130 Quincy Ave
Brockton, MA 02302-2803

Phone

(508) 941-6412

Fax

(508) 941-6413

NPI assigned

Dec 14, 2006

Last updated

May 27, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590537600000",
    "number": "1407918758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 QUINCY AVE",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023022803",
            "telephone_number": "508-941-6412",
            "fax_number": "508-941-6413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 QUINCY AVE",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023022803",
            "telephone_number": "508-941-6412",
            "fax_number": "508-941-6413"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Compass Way",
            "address_2": "Suite 208",
            "address_purpose": "LOCATION",
            "city": "East Bridgewater",
            "state": "MA",
            "postal_code": "023331465",
            "country_code": "US",
            "telephone_number": "508-350-2222",
            "fax_number": "508-350-2316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AMBROSE",
        "first_name": "SANDRA",
        "middle_name": "A",
        "credential": "NUTRITIONIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-14",
        "last_updated": "2020-05-27",
        "certification_date": "2020-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "MA",
            "license": "1312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.