Provider Demographics
NPI:1649572884
Name:NEALE, SONIA B (RD,CDE,MS)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:B
Last Name:NEALE
Suffix:
Gender:F
Credentials:RD,CDE,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 N 1770 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2178
Mailing Address - Country:US
Mailing Address - Phone:435-752-5646
Mailing Address - Fax:
Practice Address - Street 1:1672 N 1770 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2178
Practice Address - Country:US
Practice Address - Phone:435-752-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1097574901133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal