MEDICARE: SARA BETH WISEHART RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	37002310A	IN

General Provider Information

NPI Number	:	1720692015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA BETH WISEHART RD

Provider Business Mailing Address
First Line	:	6135 CONNIE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-9241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9105 E. 56TH STREET
Second Line	:	SUITE J, #2009
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46216-9241
Country	:	US
Telephone Number	:	317-517-6249
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2020
Last Update Date	:	08/19/2025

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Directions to “ SARA BETH WISEHART RD” Practice Location

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