Provider Demographics
NPI:1427109628
Name:CLARK, SHARON SAMMONS (MS, RD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:SAMMONS
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8006 SENEDO RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JACKSON
Mailing Address - State:VA
Mailing Address - Zip Code:22842-2232
Mailing Address - Country:US
Mailing Address - Phone:540-477-4292
Mailing Address - Fax:540-477-3502
Practice Address - Street 1:8006 SENEDO RD
Practice Address - Street 2:
Practice Address - City:MOUNT JACKSON
Practice Address - State:VA
Practice Address - Zip Code:22842-2232
Practice Address - Country:US
Practice Address - Phone:540-477-3514
Practice Address - Fax:540-477-3502
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered