Healthcare Provider Details

I. General information

NPI: 1093599250
Provider Name (Legal Business Name): SABRENA LAYNE REID MS, RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 GREEN ST
HUNTINGTON NY
11743-3393
US

IV. Provider business mailing address

187 LENOX ST
PORT JEFFERSON STATION NY
11776-2611
US

V. Phone/Fax

Practice location:
  • Phone: 516-200-1902
  • Fax:
Mailing address:
  • Phone: 631-942-6266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1545746
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: