Provider Demographics
NPI:1750983722
Name:CZARNECKI, SOPHIA MARIE ELIZABETH (RD)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:MARIE ELIZABETH
Last Name:CZARNECKI
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 1:439 BENEFIT ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-2934
Mailing Address - Country:US
Mailing Address - Phone:401-262-0840
Mailing Address - Fax:
Practice Address - Street 1:439 BENEFIT ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-2934
Practice Address - Country:US
Practice Address - Phone:401-262-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN01091133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered