Provider Demographics
NPI:1154570182
Name:SCUNCIO, SANDRA (RD, LDN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SCUNCIO
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 COUNTRY CLUB DRIVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-4912
Mailing Address - Country:US
Mailing Address - Phone:401-741-0147
Mailing Address - Fax:
Practice Address - Street 1:91 COUNTRY CLUB DRIVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-4912
Practice Address - Country:US
Practice Address - Phone:401-741-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00486133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered