Provider Demographics
NPI:1386462703
Name:WILLS, SYDNEY SPIGLE (RDN)
Entity type:Individual
Prefix:MRS
First Name:SYDNEY
Middle Name:SPIGLE
Last Name:WILLS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BEACHMONT DR
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:24064-1324
Mailing Address - Country:US
Mailing Address - Phone:540-765-9527
Mailing Address - Fax:
Practice Address - Street 1:201 BEACHMONT DR
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:24064-1324
Practice Address - Country:US
Practice Address - Phone:540-765-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86171911133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered