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NPI Code Detail

MEDICARE: SKYLER GRAY SABETPOUR RDN

MEDICARE: SKYLER GRAY SABETPOUR RDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianDX6167MD

General Provider Information

NPI Number : 1255130191
Entity Type Code : Individual
Provider Name (Legal Business Name) : SKYLER GRAY SABETPOUR RDN
Provider Business Mailing Address
First Line : 3302 HUDSON ST
Second Line :
City : BALTIMORE
State : MD
Zip : 21224-5137
Country : US
Telephone Number : 469-386-5859
Fax Number :
Provider Business Practice Location Address
First Line : 5100 W GENESEE ST
Second Line :
City : CAMILLUS
State : NY
Zip : 13031-2354
Country : US
Telephone Number : 315-401-0590
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2025
Last Update Date : 03/12/2025

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