Provider Demographics
NPI:1255130191
Name:SABETPOUR, SKYLER GRAY (RDN)
Entity type:Individual
Prefix:
First Name:SKYLER
Middle Name:GRAY
Last Name:SABETPOUR
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5137
Mailing Address - Country:US
Mailing Address - Phone:469-386-5859
Mailing Address - Fax:
Practice Address - Street 1:5100 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2354
Practice Address - Country:US
Practice Address - Phone:315-401-0590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX6167133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered