Provider Demographics
NPI:1700596491
Name:CHARITOU, SOPHIA ELIZABETH (RDN)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ELIZABETH
Last Name:CHARITOU
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:ELIZABETH
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3711 122ND AVE E
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98372-2414
Mailing Address - Country:US
Mailing Address - Phone:425-449-2361
Mailing Address - Fax:
Practice Address - Street 1:10210 123RD STREET CT E STE D
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2634
Practice Address - Country:US
Practice Address - Phone:253-227-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered