Provider Demographics
NPI:1740304070
Name:FISCHER, SHARLA (RD)
Entity type:Individual
Prefix:MRS
First Name:SHARLA
Middle Name:
Last Name:FISCHER
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 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 342 TOWER A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-3904
Mailing Address - Fax:314-251-4509
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 342 TOWER A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-3904
Practice Address - Fax:314-251-4509
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001003337133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO413050157Medicare UPIN