Provider Demographics
NPI:1245855626
Name:KING, SYLVIA R (MPP-D, RDN, LD)
Entity type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:R
Last Name:KING
Suffix:
Gender:F
Credentials:MPP-D, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-8906
Mailing Address - Country:US
Mailing Address - Phone:515-402-7400
Mailing Address - Fax:
Practice Address - Street 1:3141 CENTENNIAL BLVD STE 2141
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4094
Practice Address - Country:US
Practice Address - Phone:719-227-4219
Practice Address - Fax:719-227-4659
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1060387133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered