Provider Demographics
NPI:1801923693
Name:SAUM, DEBRA L (MS,RD,CDN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:SAUM
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 1:429 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3403
Mailing Address - Country:US
Mailing Address - Phone:631-873-5569
Mailing Address - Fax:
Practice Address - Street 1:429 2ND AVE
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-3403
Practice Address - Country:US
Practice Address - Phone:631-368-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000768-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered