Provider Demographics
NPI:1437496460
Name:JEFFERY, DEBORAH (RD)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:JEFFERY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 VIRGINIA WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1222
Mailing Address - Country:US
Mailing Address - Phone:703-201-1184
Mailing Address - Fax:703-318-3259
Practice Address - Street 1:560 HERNDON PKWY
Practice Address - Street 2:SUITE 340
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5286
Practice Address - Country:US
Practice Address - Phone:703-201-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2566133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered