Provider Demographics
NPI:1336354208
Name:HEFFRON, DEBORAH A (RD, LDN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:HEFFRON
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 KERR ST
Mailing Address - Street 2:
Mailing Address - City:ONANCOCK
Mailing Address - State:VA
Mailing Address - Zip Code:23417-4207
Mailing Address - Country:US
Mailing Address - Phone:757-787-7241
Mailing Address - Fax:
Practice Address - Street 1:29 KERR ST
Practice Address - Street 2:
Practice Address - City:ONANCOCK
Practice Address - State:VA
Practice Address - Zip Code:23417-4207
Practice Address - Country:US
Practice Address - Phone:757-787-7241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDO2248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered