Provider Demographics
NPI:1720762743
Name:DESESA, SHARON (RD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:DESESA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 WASHINGTON AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-3856
Mailing Address - Country:US
Mailing Address - Phone:860-550-4236
Mailing Address - Fax:
Practice Address - Street 1:425 WASHINGTON AVE APT 6
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-3856
Practice Address - Country:US
Practice Address - Phone:860-550-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered