Provider Demographics
NPI:1841347846
Name:O'DONOHUE, DEBBIE ANN (MS, RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:ANN
Last Name:O'DONOHUE
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:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:WURTSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12790-0465
Mailing Address - Country:US
Mailing Address - Phone:845-699-6366
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 52
Practice Address - Street 2:SWAN LAKE
Practice Address - City:SWAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12783
Practice Address - Country:US
Practice Address - Phone:845-292-6875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001487133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDPOO9Q8010Medicare ID - Type Unspecified