Provider Demographics
NPI:1184135238
Name:INSERRA, SARAH LEE (RD, CDN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LEE
Last Name:INSERRA
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LEE
Other - Last Name:HEITZMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDN
Mailing Address - Street 1:5594 VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:ORISKANY
Mailing Address - State:NY
Mailing Address - Zip Code:13424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5594 VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:ORISKANY
Practice Address - State:NY
Practice Address - Zip Code:13424
Practice Address - Country:US
Practice Address - Phone:315-725-1348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
803696133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered