Provider Demographics
NPI:1437902392
Name:DEVINE DIETITIAN NUTRITION SERVICES PLLC
Entity Type:Organization
Organization Name:DEVINE DIETITIAN NUTRITION SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:631-455-1498
Mailing Address - Street 1:27 BREWSTER LN
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2417
Mailing Address - Country:US
Mailing Address - Phone:631-455-1498
Mailing Address - Fax:
Practice Address - Street 1:27 BREWSTER LN
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2417
Practice Address - Country:US
Practice Address - Phone:631-455-1498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty