Provider Demographics
NPI:1063175511
Name:MITCHELL, SUNNY WADE (RDN)
Entity type:Individual
Prefix:
First Name:SUNNY
Middle Name:WADE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 BIG SPRING HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-6863
Mailing Address - Country:US
Mailing Address - Phone:931-309-0231
Mailing Address - Fax:
Practice Address - Street 1:651 BIG SPRING HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-6863
Practice Address - Country:US
Practice Address - Phone:931-309-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered