Healthcare Provider Details

I. General information

NPI: 1982250718
Provider Name (Legal Business Name): TARA SANGUINETTE MS, CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 E MONUMENT ST
BALTIMORE MD
21287-0028
US

IV. Provider business mailing address

2024 E MONUMENT ST
BALTIMORE MD
21287-0028
US

V. Phone/Fax

Practice location:
  • Phone: 443-287-9520
  • Fax:
Mailing address:
  • Phone: 443-287-9520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX4985
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: