Provider Demographics
NPI:1033503057
Name:STITES, SARAH (RD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:STITES
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 1:34 SHERBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2816
Mailing Address - Country:US
Mailing Address - Phone:973-410-0751
Mailing Address - Fax:973-926-2978
Practice Address - Street 1:166 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2016
Practice Address - Country:US
Practice Address - Phone:973-926-2884
Practice Address - Fax:973-926-2978
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ727622133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered