Active NPI
Sonya Marie Phares, R.D.
- Registered Dietitian
- Saint Louis, MO
National Provider Identifier
1902093669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT80178
- Practice address
- 12647 Olive Blvd
Saint Louis, MO 63141-6345 - Phone
- (713) 705-5287
- NPI assigned
- Sep 26, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT80178 | TX | Primary |
Addresses
Primary practice location
12647 Olive Blvd
Saint Louis, MO 63141-6345
Mailing address
1029 Hunters Trce
Mt Pleasant, SC 29464-3619
Phone (713) 705-5287
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT80178 | TX | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190764800000",
"number": "1902093669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1029 HUNTERS TRCE",
"city": "MT PLEASANT",
"state": "SC",
"postal_code": "294643619",
"telephone_number": "713-705-5287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12647 OLIVE BLVD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416345",
"telephone_number": "713-705-5287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHARES",
"first_name": "SONYA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "R.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-26",
"last_updated": "2007-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT80178",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.