Provider Demographics
NPI:1437701240
Name:SZATKOWSKI, SARA M
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:SZATKOWSKI
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 1:3849 DORA DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-6106
Mailing Address - Country:US
Mailing Address - Phone:248-720-9948
Mailing Address - Fax:
Practice Address - Street 1:3849 DORA DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-6106
Practice Address - Country:US
Practice Address - Phone:248-720-9948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86081002133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered