Provider Demographics
NPI:1235540139
Name:SAA, LAUDREY
Entity Type:Individual
Prefix:
First Name:LAUDREY
Middle Name:
Last Name:SAA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FORDHAM PLZ STE 101010TH
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5871
Mailing Address - Country:US
Mailing Address - Phone:718-405-4468
Mailing Address - Fax:
Practice Address - Street 1:1 FORDHAM PLZ STE 101010
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5871
Practice Address - Country:US
Practice Address - Phone:718-405-4468
Practice Address - Fax:718-653-2914
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004442133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered