Provider Demographics
NPI:1255110797
Name:FAHEY, SAVANNAH (RD)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:FAHEY
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 1:141 E RIVERSIDE DR APT 11B
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33469-3250
Mailing Address - Country:US
Mailing Address - Phone:561-222-6609
Mailing Address - Fax:
Practice Address - Street 1:141 E RIVERSIDE DR APT 11B
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33469-3250
Practice Address - Country:US
Practice Address - Phone:561-222-6609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND10817133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered