Healthcare Provider Details

I. General information

NPI: 1184588196
Provider Name (Legal Business Name): SYDNEY RURY RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 LOUISVILLE AVE APT 2S
SAINT LOUIS MO
63139-3328
US

IV. Provider business mailing address

1115 LOUISVILLE AVE APT 2S
SAINT LOUIS MO
63139-3328
US

V. Phone/Fax

Practice location:
  • Phone: 563-552-6313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: