Provider Demographics
NPI:1679159123
Name:DEBNAM, ISABEL (RDN)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:DEBNAM
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 1:15 1ST AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-4919
Mailing Address - Country:US
Mailing Address - Phone:203-868-9301
Mailing Address - Fax:
Practice Address - Street 1:3421 VILLA LN
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3056
Practice Address - Country:US
Practice Address - Phone:707-251-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT86172116133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered