Provider Demographics
NPI:1861253197
Name:DEROSA, SARAH (RDN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:DEROSA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MINEOLA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2042
Mailing Address - Country:US
Mailing Address - Phone:516-616-5500
Mailing Address - Fax:
Practice Address - Street 1:125 MINEOLA AVE STE 200
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2042
Practice Address - Country:US
Practice Address - Phone:516-616-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered