Basic Information
Provider Information
NPI: 1598323586
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOND
FirstName: SARAH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 MEDICAL CENTER BLVD
Address2:  
City: WINSTON SALEM
State: NC
PostalCode: 271570001
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1 MEDICAL CENTER BLVD
Address2:  
City: WINSTON SALEM
State: NC
PostalCode: 271570001
CountryCode: US
TelephoneNumber: 3367162011
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/04/2019
LastUpdateDate: 06/04/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000XL004318NCY Dietary & Nutritional Service ProvidersDietitian, Registered 

ID Information
IDTypeStateIssuerDescription
8600291901 COMMISSION ON DIETETIC REGISTRATIONOTHER
L00431801NCNORTH CAROLINA BOARD OF DIETETICS/NUTRITIONOTHER


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