Provider Demographics
NPI:1154299758
Name:FUNK, SARAH (MS RD LD/N)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:FUNK
Suffix:
Gender:F
Credentials:MS RD LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10322 107TH AVE N
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-4115
Mailing Address - Country:US
Mailing Address - Phone:727-225-6582
Mailing Address - Fax:
Practice Address - Street 1:10322 107TH AVE N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-4115
Practice Address - Country:US
Practice Address - Phone:727-225-6582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9532133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered