Provider Demographics
NPI:1346019098
Name:LE, SARAH (RD, LD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 LIBERTY CIR
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4593
Mailing Address - Country:US
Mailing Address - Phone:952-564-1721
Mailing Address - Fax:
Practice Address - Street 1:1685 LIBERTY CIR
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-4593
Practice Address - Country:US
Practice Address - Phone:952-564-1721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered