Provider Demographics
NPI:1437488392
Name:SOBUS, RYAN SUMMERFORD (MPH, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:RYAN
Middle Name:SUMMERFORD
Last Name:SOBUS
Suffix:
Gender:F
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 HEALTH PARK STE 325
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4731
Mailing Address - Country:US
Mailing Address - Phone:919-870-1001
Mailing Address - Fax:919-360-8002
Practice Address - Street 1:8300 HEALTH PARK STE 325
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4731
Practice Address - Country:US
Practice Address - Phone:919-870-1001
Practice Address - Fax:919-360-8002
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002886133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered