Provider Demographics
NPI:1669962478
Name:GEHA, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GEHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 BLAIRMONT LN
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-7027
Mailing Address - Country:US
Mailing Address - Phone:970-309-4490
Mailing Address - Fax:
Practice Address - Street 1:848 BLAIRMONT LN
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-7027
Practice Address - Country:US
Practice Address - Phone:970-309-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9012133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist