Provider Demographics
NPI:1851352017
Name:DICEY, SANA J (RD)
Entity Type:Individual
Prefix:
First Name:SANA
Middle Name:J
Last Name:DICEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SANA
Other - Middle Name:J
Other - Last Name:MENTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1430 MARY DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-1944
Mailing Address - Country:US
Mailing Address - Phone:814-410-3056
Mailing Address - Fax:
Practice Address - Street 1:10455 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7046
Practice Address - Country:US
Practice Address - Phone:814-624-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNT725581AMedicare ID - Type Unspecified