Healthcare Provider Details

I. General information

NPI: 1184094971
Provider Name (Legal Business Name): DEBORAH LEE FAORO-RODRIGUES RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ATWELL RD
COOPERSTOWN NY
13326-1301
US

IV. Provider business mailing address

1 ATWELL RD
COOPERSTOWN NY
13326-1301
US

V. Phone/Fax

Practice location:
  • Phone: 607-547-3539
  • Fax: 607-547-5605
Mailing address:
  • Phone: 607-547-3539
  • Fax: 607-547-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000940-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: