Provider Demographics
NPI:1356790760
Name:SACKS DEC, STEFANIE (MS, CNS, CDN)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:SACKS DEC
Suffix:
Gender:F
Credentials:MS, CNS, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N FARRAGUT RD
Mailing Address - Street 2:
Mailing Address - City:MONTAUK
Mailing Address - State:NY
Mailing Address - Zip Code:11954-5088
Mailing Address - Country:US
Mailing Address - Phone:917-686-3778
Mailing Address - Fax:
Practice Address - Street 1:17 N FARRAGUT RD
Practice Address - Street 2:
Practice Address - City:MONTAUK
Practice Address - State:NY
Practice Address - Zip Code:11954-5088
Practice Address - Country:US
Practice Address - Phone:917-686-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007511133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist