Provider Demographics
NPI:1336601905
Name:FAKHOURY, FATIMA ZOHRA (MS RD CDN)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:ZOHRA
Last Name:FAKHOURY
Suffix:
Gender:F
Credentials:MS RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TODD HILL RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-3904
Mailing Address - Country:US
Mailing Address - Phone:917-640-8465
Mailing Address - Fax:
Practice Address - Street 1:51 SPRINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-1682
Practice Address - Country:US
Practice Address - Phone:845-640-1900
Practice Address - Fax:845-243-2304
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered