Provider Demographics
NPI:1821764119
Name:BORISKY, SARAH (RD LD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BORISKY
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18675 BERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-8730
Mailing Address - Country:US
Mailing Address - Phone:913-927-6111
Mailing Address - Fax:
Practice Address - Street 1:326 SE DOUGLAS ST STE B
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2713
Practice Address - Country:US
Practice Address - Phone:816-524-5432
Practice Address - Fax:816-524-5432
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021030026133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty