Provider Demographics
NPI:1700238417
Name:MICALLEF, SARAH (RD)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:MICALLEF
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W UNIVERSITY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1873
Mailing Address - Country:US
Mailing Address - Phone:248-652-5660
Mailing Address - Fax:248-652-3950
Practice Address - Street 1:1000 W UNIVERSITY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1873
Practice Address - Country:US
Practice Address - Phone:248-652-5660
Practice Address - Fax:248-652-3950
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI960918133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered