Provider Demographics
NPI:1265624639
Name:BLAHA, SARA QUALLS (LDN, RD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:QUALLS
Last Name:BLAHA
Suffix:
Gender:F
Credentials:LDN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6522
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-0522
Mailing Address - Country:US
Mailing Address - Phone:757-499-2018
Mailing Address - Fax:757-499-2017
Practice Address - Street 1:638 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5216
Practice Address - Country:US
Practice Address - Phone:757-499-2018
Practice Address - Fax:757-499-2017
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC851880133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered