Provider Demographics
NPI:1336026244
Name:PEDERSON, SIRI A (MS, RDN)
Entity type:Individual
Prefix:
First Name:SIRI
Middle Name:A
Last Name:PEDERSON
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 BRIGHTON PARK DR APT 12
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5987
Mailing Address - Country:US
Mailing Address - Phone:406-350-0243
Mailing Address - Fax:
Practice Address - Street 1:304 BRIGHTON PARK DR APT 12
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5987
Practice Address - Country:US
Practice Address - Phone:406-350-0243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86329751133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered