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General NPI Number Information
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NPI Number | 1780959296
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Entity Type | Individual
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Provider Name | SARAH UDELL MS, RD/LD
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Gender | Female
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 05/03/2013
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Provider Practice Location Address
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Address Line | 100 MEDICAL PLZ SUITE 1203
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City | LAKE SAINT LOUIS
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State | MO
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Zip | 63367-1366
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Country | US
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Telephone | 636-625-7733
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MEDICAL PLZ SUITE 1203
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1366
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Country | US
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Telephone | 636-755-3013
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2011034455
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License Number State | MO
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