Provider Demographics
NPI:1154569374
Name:BLAIR, DEBRA ANNE (RD, CDE)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ANNE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 HIGHWAY 35
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750
Mailing Address - Country:US
Mailing Address - Phone:732-746-3708
Mailing Address - Fax:732-359-0249
Practice Address - Street 1:2150 HIGHWAY 35
Practice Address - Street 2:SUITE 250
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750
Practice Address - Country:US
Practice Address - Phone:732-746-3708
Practice Address - Fax:732-359-0249
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14518133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered