Provider Demographics
NPI:1679876478
Name:COOPER, SARA E (RD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:COOPER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15217 JEWEL AVE
Mailing Address - Street 2:1L
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1435
Mailing Address - Country:US
Mailing Address - Phone:516-993-4299
Mailing Address - Fax:
Practice Address - Street 1:15217 JEWEL AVE
Practice Address - Street 2:1L
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1435
Practice Address - Country:US
Practice Address - Phone:516-993-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered