Provider Demographics
NPI:1518593136
Name:STUDLEY, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:STUDLEY
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 1:1410 TERRACE DR APT 206
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1771
Mailing Address - Country:US
Mailing Address - Phone:507-438-0215
Mailing Address - Fax:
Practice Address - Street 1:1410 TERRACE DR APT 206
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1771
Practice Address - Country:US
Practice Address - Phone:507-438-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-15
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered