Provider Demographics
NPI:1093113029
Name:SWINDELL, SARA (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:SWINDELL
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 INDEPENDENCE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4216
Mailing Address - Country:US
Mailing Address - Phone:336-404-3802
Mailing Address - Fax:336-600-1738
Practice Address - Street 1:1918 BRADFORD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5614
Practice Address - Country:US
Practice Address - Phone:336-404-3802
Practice Address - Fax:336-600-1738
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003836133V00000X
NC1050617133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered