Provider Demographics
NPI:1679764518
Name:JOHNSON, SHARON ANN (RD , CDN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RD , CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-3411
Mailing Address - Country:US
Mailing Address - Phone:203-453-2086
Mailing Address - Fax:
Practice Address - Street 1:29 NORTON AVE
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-3411
Practice Address - Country:US
Practice Address - Phone:203-453-2086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000246133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered