Provider Demographics
NPI:1063039402
Name:ST CYR-PAUL, DEBORAH (RD, LD/N)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:ST CYR-PAUL
Suffix:
Gender:F
Credentials: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 1:429 DEAN CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8109
Mailing Address - Country:US
Mailing Address - Phone:321-624-5723
Mailing Address - Fax:
Practice Address - Street 1:429 DEAN CREEK LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-8109
Practice Address - Country:US
Practice Address - Phone:321-624-5723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3543133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered