Provider Demographics
NPI:1528766581
Name:POLK, SARAH ELISE (MS, RDN, LD)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ELISE
Last Name:POLK
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4134 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-2705
Mailing Address - Country:US
Mailing Address - Phone:314-246-9072
Mailing Address - Fax:314-627-7007
Practice Address - Street 1:10004 KENNERLY RD STE 370A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-5118
Practice Address - Country:US
Practice Address - Phone:314-246-9072
Practice Address - Fax:314-627-7007
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021037948133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered