Provider Demographics
NPI:1801609318
Name:FREDLEY, DEBORAH (RD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:FREDLEY
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 1:22 FINCH WOOD LN
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1180
Mailing Address - Country:US
Mailing Address - Phone:585-474-4490
Mailing Address - Fax:
Practice Address - Street 1:22 FINCH WOOD LN
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1180
Practice Address - Country:US
Practice Address - Phone:585-474-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered