Provider Demographics
NPI:1902325293
Name:SPARR NUTRITION SERVICES LLC
Entity type:Organization
Organization Name:SPARR NUTRITION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:POORNIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMANDUR
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:248-760-7462
Mailing Address - Street 1:1957 MIDCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1164
Mailing Address - Country:US
Mailing Address - Phone:248-760-7462
Mailing Address - Fax:
Practice Address - Street 1:1957 MIDCHESTER DRIVE
Practice Address - Street 2:
Practice Address - City:WESTBLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324
Practice Address - Country:US
Practice Address - Phone:248-760-7462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI847864133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty