Provider Demographics
NPI:1548957384
Name:JOHNSON, SYDNEY K (RD)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 PLATTE XING UNIT 204
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-9301
Mailing Address - Country:US
Mailing Address - Phone:336-817-0561
Mailing Address - Fax:
Practice Address - Street 1:10010 PLATTE XING UNIT 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-9301
Practice Address - Country:US
Practice Address - Phone:336-817-0561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered