Provider Demographics
NPI:1871398529
Name:SERRA, ALEXANDRIA RAE
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:RAE
Last Name:SERRA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 LILLIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-3933
Mailing Address - Country:US
Mailing Address - Phone:631-901-7755
Mailing Address - Fax:
Practice Address - Street 1:428 ROUTE 25A BLDG A
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2514
Practice Address - Country:US
Practice Address - Phone:631-509-5544
Practice Address - Fax:844-697-0645
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered