Provider Demographics
NPI:1518956671
Name:SARA, CHERYL A (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:A
Last Name:SARA
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 1:29000 CENTER RIDGE RD
Mailing Address - Street 2:NUTRITION SERVICES ST JOHN WEST SHORE HOSPITAL
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5293
Mailing Address - Country:US
Mailing Address - Phone:440-827-5588
Mailing Address - Fax:440-303-0099
Practice Address - Street 1:29000 CENTER RIDGE RD
Practice Address - Street 2:NUTRITION SERVICES ST. JOHN WEST SHORE HOSPITAL
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5293
Practice Address - Country:US
Practice Address - Phone:440-827-5588
Practice Address - Fax:440-827-5588
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD3292133V00000X
OHCDR803003133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSAMT73361Medicare ID - Type Unspecified