Provider Demographics
NPI:1093960270
Name:STEWART, SHARON (MS, RD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:415 W PERKINS ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4807
Mailing Address - Country:US
Mailing Address - Phone:707-367-0172
Mailing Address - Fax:707-467-9522
Practice Address - Street 1:617 W STANDLEY ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4222
Practice Address - Country:US
Practice Address - Phone:707-367-0172
Practice Address - Fax:707-467-9522
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA717687133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ277032Medicare UPIN