Provider Demographics
NPI:1326159534
Name:BOYDEN, SALLY R (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:R
Last Name:BOYDEN
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:MS
Other - First Name:SALLY
Other - Middle Name:M
Other - Last Name:RIMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LD
Mailing Address - Street 1:3463 W 155TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3002
Mailing Address - Country:US
Mailing Address - Phone:216-941-6105
Mailing Address - Fax:
Practice Address - Street 1:7007 POWERS BLVD
Practice Address - Street 2:PARMA COMMUNITY GENERAL HOSPITAL
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5495
Practice Address - Country:US
Practice Address - Phone:440-743-2193
Practice Address - Fax:440-743-2286
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1312133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered