Provider Demographics
NPI:1538348024
Name:ULLMAN, SALLY MAY (RD, CDE, LDN)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:MAY
Last Name:ULLMAN
Suffix:
Gender:F
Credentials:RD, CDE, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 STONE CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4537
Mailing Address - Country:US
Mailing Address - Phone:919-848-7778
Mailing Address - Fax:919-676-1158
Practice Address - Street 1:1212 STONE CREEK WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4537
Practice Address - Country:US
Practice Address - Phone:919-848-7778
Practice Address - Fax:919-676-1158
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000297133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered