Provider Demographics
NPI:1699386169
Name:RIDLEY, SEQUOIA A (RDN)
Entity Type:Individual
Prefix:
First Name:SEQUOIA
Middle Name:A
Last Name:RIDLEY
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 1:7015 BEROLINA LN APT 1536
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8710
Mailing Address - Country:US
Mailing Address - Phone:704-493-9791
Mailing Address - Fax:
Practice Address - Street 1:7015 BEROLINA LN APT 1536
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8710
Practice Address - Country:US
Practice Address - Phone:704-493-9791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered