Provider Demographics
NPI:1639459787
Name:SUARDINI, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SUARDINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:GRZELAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6767 S SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1283
Mailing Address - Country:US
Mailing Address - Phone:303-779-9355
Mailing Address - Fax:
Practice Address - Street 1:6767 S SPRUCE ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1283
Practice Address - Country:US
Practice Address - Phone:303-779-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1064727133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered