Provider Demographics
NPI:1679185763
Name:CULLY, SARA ASHLEY (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ASHLEY
Last Name:CULLY
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 CALASH WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-6000
Mailing Address - Country:US
Mailing Address - Phone:757-353-0850
Mailing Address - Fax:
Practice Address - Street 1:1577 LASKIN RD STE 105
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6464
Practice Address - Country:US
Practice Address - Phone:757-422-4728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1099269133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered