Provider Demographics
NPI:1316795107
Name:MOY, SARA ANN (RD)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ANN
Last Name:MOY
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 1:133 BRIDGEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-4501
Mailing Address - Country:US
Mailing Address - Phone:406-240-5514
Mailing Address - Fax:
Practice Address - Street 1:133 BRIDGEHAVEN DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-4501
Practice Address - Country:US
Practice Address - Phone:406-240-5514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007425133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered