Provider Demographics
NPI:1710562095
Name:MOODY, SARAH LEE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LEE
Last Name:MOODY
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 1:1583 TRANSYLVANIA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-5169
Mailing Address - Country:US
Mailing Address - Phone:330-208-8407
Mailing Address - Fax:
Practice Address - Street 1:1583 TRANSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-5169
Practice Address - Country:US
Practice Address - Phone:330-208-8407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide