Provider Demographics
NPI:1376690297
Name:PRESNELL, SALLY T (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:T
Last Name:PRESNELL
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 SANDY LN
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-3610
Mailing Address - Country:US
Mailing Address - Phone:276-596-6634
Mailing Address - Fax:
Practice Address - Street 1:6801 GOV G C PEERY HWY
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2305
Practice Address - Country:US
Practice Address - Phone:276-596-6634
Practice Address - Fax:276-596-6663
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2010-06-21
Deactivation Date:2008-09-15
Deactivation Code:
Reactivation Date:2008-10-20
Provider Licenses
StateLicense IDTaxonomies
VA706884133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08469Medicare ID - Type Unspecified