Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X009556-1 | NY |
NPI | 1609892314 |
---|---|
Provider Name | Dr. Sloane Deluke Eusebio |
First Address | Clifton Park, NY 12065-3227 |
Second Address | Clifton Park, NY 12065-3200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 16/01/2019 |