Provider Demographics
NPI:1871072215
Name:SWEENEY, CAROL ELIZABETH (MA, RD, LDN, FAND)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ELIZABETH
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MA, RD, LDN, FAND
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:ELIZABETH
Other - Last Name:RUDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:482 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-1120
Mailing Address - Country:US
Mailing Address - Phone:610-888-7218
Mailing Address - Fax:
Practice Address - Street 1:482 DOUGLAS DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-1120
Practice Address - Country:US
Practice Address - Phone:610-888-7218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000185133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered