Provider Demographics
NPI:1831601368
Name:HEITZMAN, SARAH BROOKE (RDN, LD)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:BROOKE
Last Name:HEITZMAN
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 PINCKNEY MARSH LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-0307
Mailing Address - Country:US
Mailing Address - Phone:518-641-8891
Mailing Address - Fax:
Practice Address - Street 1:50 E HOSPITAL ST STE 6
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3149
Practice Address - Country:US
Practice Address - Phone:803-435-3408
Practice Address - Fax:803-435-3165
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1654133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered