Provider Demographics
NPI:1386821288
Name:STALL, SHARON (RD)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:STALL
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 1:221 WILSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1222
Mailing Address - Country:US
Mailing Address - Phone:585-473-5274
Mailing Address - Fax:
Practice Address - Street 1:221 WILSHIRE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1222
Practice Address - Country:US
Practice Address - Phone:585-473-5274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal