Provider Demographics
NPI:1528891223
Name:TYSON, SARAH (MS, RD, LD, CSR)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:TYSON
Suffix:
Gender:F
Credentials:MS, RD, LD, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8729 DUNLAP ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-7725
Mailing Address - Country:US
Mailing Address - Phone:504-432-4057
Mailing Address - Fax:
Practice Address - Street 1:8729 DUNLAP ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-7725
Practice Address - Country:US
Practice Address - Phone:504-432-4057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86077202133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal