Provider Demographics
NPI:1821045022
Name:SANFORD-ABERNATHY, EUDELL NMN (RD/ CDN)
Entity Type:Individual
Prefix:MS
First Name:EUDELL
Middle Name:NMN
Last Name:SANFORD-ABERNATHY
Suffix:
Gender:F
Credentials:RD/ CDN
Other - Prefix:MS
Other - First Name:EUDELL
Other - Middle Name:
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:000986-1
Mailing Address - Street 1:400 2ND AVE
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4010
Mailing Address - Country:US
Mailing Address - Phone:212-686-7500
Mailing Address - Fax:212-889-0926
Practice Address - Street 1:423 E 23RD ST
Practice Address - Street 2:G670
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5011
Practice Address - Country:US
Practice Address - Phone:212-686-7500
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000986-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered