Provider Demographics
NPI:1801360813
Name:MADTES, SARA (RD, CDE)
Entity Type:Individual
Prefix:MISS
First Name:SARA
Middle Name:
Last Name:MADTES
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 DEMOTT AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1807
Mailing Address - Country:US
Mailing Address - Phone:516-287-9719
Mailing Address - Fax:
Practice Address - Street 1:3016 30TH DR STE 1B
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1890
Practice Address - Country:US
Practice Address - Phone:516-287-9719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86002087133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered