Provider Demographics
NPI:1497099618
Name:STUART, SORAI SUSANNE S (ND)
Entity Type:Individual
Prefix:DR
First Name:SORAI SUSANNE
Middle Name:S
Last Name:STUART
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 536212
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75053
Mailing Address - Country:US
Mailing Address - Phone:817-642-3014
Mailing Address - Fax:
Practice Address - Street 1:2825 N. STATE HWY 360
Practice Address - Street 2:710
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050
Practice Address - Country:US
Practice Address - Phone:817-642-3014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX175F00000X
NVANMA (NONE)133N00000X
TXCT - ( I-ACT)174400000X
TXMT001400225700000X
COCOMT6552225700000X
NVANMA174H00000X
NVANMA - NONE101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174H00000XOther Service ProvidersHealth Educator
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional