Provider Demographics
NPI:1275199242
Name:SULLIVAN, SARAH JOAN (RDN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JOAN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 N MOUNTAIN AVE FRNT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1964
Mailing Address - Country:US
Mailing Address - Phone:203-731-1511
Mailing Address - Fax:
Practice Address - Street 1:395 N SILVERBELL RD STE 355
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2981
Practice Address - Country:US
Practice Address - Phone:520-319-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86089473133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered