Provider Demographics
NPI:1841985223
Name:GIBBONS, SARA (MS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 W 58TH ST APT 8E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2507
Mailing Address - Country:US
Mailing Address - Phone:262-352-6488
Mailing Address - Fax:
Practice Address - Street 1:58 W 58TH ST APT 8E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2507
Practice Address - Country:US
Practice Address - Phone:262-352-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist