Provider Demographics
NPI:1508553041
Name:SHOREY, SARA (RDN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SHOREY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WINDMILL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5604
Mailing Address - Country:US
Mailing Address - Phone:707-499-9876
Mailing Address - Fax:
Practice Address - Street 1:111 WINDMILL RIDGE DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5604
Practice Address - Country:US
Practice Address - Phone:707-499-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86156281133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty