Provider Demographics
NPI:1770104283
Name:WINEINGER, SIERRA JACQUELYNN (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:JACQUELYNN
Last Name:WINEINGER
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:JACQUELYNN
Other - Last Name:MENDENHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 DOUG WHITE DR STE 420
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4182
Mailing Address - Country:US
Mailing Address - Phone:843-353-5360
Mailing Address - Fax:843-353-5363
Practice Address - Street 1:920 DOUG WHITE DR STE 420
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4182
Practice Address - Country:US
Practice Address - Phone:843-353-5360
Practice Address - Fax:843-353-5363
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1004X
SCLRD2062RD133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric