Provider Demographics
NPI:1245192913
Name:BLACKMAN, DEBORAH SHARON (RDN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SHARON
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 NW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3871
Mailing Address - Country:US
Mailing Address - Phone:954-675-9497
Mailing Address - Fax:
Practice Address - Street 1:4850 NW 22ND ST
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-3871
Practice Address - Country:US
Practice Address - Phone:954-675-9497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4244133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty