Provider Demographics
NPI:1477910073
Name:WIMBERLEY, SALLY REED (RD)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:REED
Last Name:WIMBERLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:GRACE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:DEPT. OF SURGERY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-828-5134
Practice Address - Fax:804-828-0191
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86031036133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered