Provider Demographics
NPI:1124182605
Name:ZUMWALT, SALLY ANNE (RD)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ANNE
Last Name:ZUMWALT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 MIZZEN LN
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1536
Mailing Address - Country:US
Mailing Address - Phone:650-726-6738
Mailing Address - Fax:
Practice Address - Street 1:10080 N WOLFE RD
Practice Address - Street 2:SUITE SW3-160
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2515
Practice Address - Country:US
Practice Address - Phone:408-342-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL654928133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered