Provider Demographics
NPI:1841879459
Name:POPOLIZIO, DEBORAH (RD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:POPOLIZIO
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 1:151 YELLOW JACKET CIR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7329
Mailing Address - Country:US
Mailing Address - Phone:631-804-8835
Mailing Address - Fax:
Practice Address - Street 1:500 S MAIN ST STE 113
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-3228
Practice Address - Country:US
Practice Address - Phone:631-804-8835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC006052133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered