Basic Information
| Provider Information | |||||||||
| NPI: | 1821045022 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANFORD-ABERNATHY | ||||||||
| FirstName: | EUDELL | ||||||||
| MiddleName: | NMN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RD/ CDN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SANFORD | ||||||||
| OtherFirstName: | EUDELL | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | 000986-1 | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 400 2ND AVE | ||||||||
| Address2: | SUITE 4A | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100104010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126867500 | ||||||||
| FaxNumber: | 2128890926 | ||||||||
| Practice Location | |||||||||
| Address1: | 423 E 23RD ST | ||||||||
| Address2: | G670 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100105011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126867500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | X | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 000986-1 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.