Provider Demographics
NPI:1245912872
Name:REESE, SOPHIE ELIZABETH (RD, LDN)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:ELIZABETH
Last Name:REESE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6552 GENTRY CIR APT 104
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9853
Mailing Address - Country:US
Mailing Address - Phone:828-773-6872
Mailing Address - Fax:
Practice Address - Street 1:730 HIGHLAND OAKS DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7154
Practice Address - Country:US
Practice Address - Phone:336-646-7323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007423133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty