Basic Information
| Provider Information | |||||||||
| NPI: | 1689198830 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNEAD | ||||||||
| FirstName: | LARA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10527 MONTROSE AVE APT 202 | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208144149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3616337291 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9805 DAMERON DR RM 6 | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209025717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017547848 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2017 | ||||||||
| LastUpdateDate: | 07/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DX3532 | MD | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.