Provider Demographics
NPI:1093599250
Name:REID, SABRENA LAYNE (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:SABRENA
Middle Name:LAYNE
Last Name:REID
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 LENOX ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2611
Mailing Address - Country:US
Mailing Address - Phone:631-942-6266
Mailing Address - Fax:
Practice Address - Street 1:44 GREEN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3393
Practice Address - Country:US
Practice Address - Phone:516-200-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1545746133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty