Provider Demographics
NPI:1811026743
Name:HASSELL, SARA ELLEN (RD CN LD)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ELLEN
Last Name:HASSELL
Suffix:
Gender:F
Credentials:RD CN LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13321 VENDETTA WAY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-7631
Mailing Address - Country:US
Mailing Address - Phone:985-772-1551
Mailing Address - Fax:502-241-2602
Practice Address - Street 1:13321 VENDETTA WAY UNIT 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-7631
Practice Address - Country:US
Practice Address - Phone:985-772-1551
Practice Address - Fax:502-241-2602
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY169345133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered