Provider Demographics
NPI:1245711589
Name:SABALLOS-TERCERO, FADHYLLA NAZARETH (RD)
Entity type:Individual
Prefix:MS
First Name:FADHYLLA
Middle Name:NAZARETH
Last Name:SABALLOS-TERCERO
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 1:871 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3913
Mailing Address - Country:US
Mailing Address - Phone:718-991-0605
Mailing Address - Fax:
Practice Address - Street 1:871 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3913
Practice Address - Country:US
Practice Address - Phone:718-991-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1108586133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered