MEDICARE: ALEXANDRA NOEL SARKISIAN MS, RDN

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

General Provider Information

NPI Number	:	1760006837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA NOEL SARKISIAN MS, RDN

Provider Business Mailing Address
First Line	:	3701 DOTY RD
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-7509
Country	:	US
Telephone Number	:	815-334-3113
Fax Number	:

Provider Business Practice Location Address
First Line	:	23640 N LOOKOUT POINTE RD
Second Line	:
City	:	PORT BARRINGTON
State	:	IL
Zip	:	60010-1083
Country	:	US
Telephone Number	:	847-769-6771
Fax Number	:

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

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	06/03/2020

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