Provider Demographics
NPI:1245310028
Name:YANNASCOLI, DEBORAH JANE (MA, RD, CDN)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JANE
Last Name:YANNASCOLI
Suffix:
Gender:F
Credentials:MA, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8543 LAMP POST CIR
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9389
Mailing Address - Country:US
Mailing Address - Phone:315-682-4116
Mailing Address - Fax:315-682-4116
Practice Address - Street 1:7000 E GENESEE ST
Practice Address - Street 2:BLDG C
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1131
Practice Address - Country:US
Practice Address - Phone:315-251-1035
Practice Address - Fax:315-251-1035
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002428-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered