Provider Demographics
NPI:1265285399
Name:SPERRAZZA, TRACEY (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:SPERRAZZA
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28013 OAK LN
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-6910
Mailing Address - Country:US
Mailing Address - Phone:631-697-8289
Mailing Address - Fax:
Practice Address - Street 1:28013 OAK LN
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-6910
Practice Address - Country:US
Practice Address - Phone:631-697-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7560133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered