Healthcare Provider Details

I. General information

NPI: 1730851346
Provider Name (Legal Business Name): SARAH LYNN NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W GENESEE ST
CAMILLUS NY
13031-2354
US

IV. Provider business mailing address

5100 W GENESEE ST
CAMILLUS NY
13031-2354
US

V. Phone/Fax

Practice location:
  • Phone: 315-334-2306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: SARAH LYNN QUICK
Title or Position: REGISTERED DIETITIAN
Credential:
Phone: 315-401-0054