Provider Demographics
NPI:1871784116
Name:UPTON, SHARON KAYE (RD)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:KAYE
Last Name:UPTON
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 1:2807 N PARHAM RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4410
Mailing Address - Country:US
Mailing Address - Phone:804-346-9866
Mailing Address - Fax:804-965-0527
Practice Address - Street 1:2807 N PARHAM RD
Practice Address - Street 2:SUITE 305
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4410
Practice Address - Country:US
Practice Address - Phone:804-346-9866
Practice Address - Fax:804-965-0527
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA17379133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA278-082Medicare PIN