Provider Demographics
NPI:1437047297
Name:AGELASTO, SARA (MS, CNS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:AGELASTO
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2171 BEECH GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:VA
Mailing Address - Zip Code:22967-2104
Mailing Address - Country:US
Mailing Address - Phone:434-825-5983
Mailing Address - Fax:
Practice Address - Street 1:2171 BEECH GROVE RD
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:VA
Practice Address - Zip Code:22967-2104
Practice Address - Country:US
Practice Address - Phone:434-825-5983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist