Provider Demographics
NPI:1114536380
Name:PHILLIPS, SIERAH LAMAE (MS, RD, CSP, IBCLC)
Entity Type:Individual
Prefix:
First Name:SIERAH
Middle Name:LAMAE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS, RD, CSP, IBCLC
Other - Prefix:
Other - First Name:SIERAH
Other - Middle Name:LAMAE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2824 N SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1510
Mailing Address - Country:US
Mailing Address - Phone:405-380-6968
Mailing Address - Fax:
Practice Address - Street 1:2824 N SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1510
Practice Address - Country:US
Practice Address - Phone:405-380-6968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 133VN1004X, 2255A2300X
AZ86104198133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer