Provider Demographics
NPI:1184671505
Name:STUPIC, DEBORA LOUISE (RD LDN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORA
Middle Name:LOUISE
Last Name:STUPIC
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 OAK ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1651
Mailing Address - Country:US
Mailing Address - Phone:844-328-9473
Mailing Address - Fax:724-224-0749
Practice Address - Street 1:1099 OAK ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-1651
Practice Address - Country:US
Practice Address - Phone:844-328-9473
Practice Address - Fax:724-224-0749
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001744133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist