Provider Demographics
NPI:1093258204
Name:GUAY, SIERRA FAWN (MS, RDN, CBIS)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:FAWN
Last Name:GUAY
Suffix:
Gender:F
Credentials:MS, RDN, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4448 SURREY MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9834
Mailing Address - Country:US
Mailing Address - Phone:207-844-4353
Mailing Address - Fax:
Practice Address - Street 1:4448 SURREY MEADOWS DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-9834
Practice Address - Country:US
Practice Address - Phone:207-844-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2019-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005288133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered