Provider Demographics
NPI:1275728578
Name:DEPASTINA, DEBORAH SUSAN (RD, LD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUSAN
Last Name:DEPASTINA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-1311
Mailing Address - Country:US
Mailing Address - Phone:814-327-6252
Mailing Address - Fax:
Practice Address - Street 1:18TH MEDCOM
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:SEOUL
Practice Address - Zip Code:96205
Practice Address - Country:KP
Practice Address - Phone:814-327-6252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT03881133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered