Provider Demographics
NPI:1093522120
Name:SUDIK, MANDY ELISE (RD)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:ELISE
Last Name:SUDIK
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 1:508 PRAIRIE HILL LN
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-9726
Mailing Address - Country:US
Mailing Address - Phone:405-613-7502
Mailing Address - Fax:
Practice Address - Street 1:508 PRAIRIE HILL LN
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9726
Practice Address - Country:US
Practice Address - Phone:405-613-7502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered