Provider Demographics
NPI:1003166257
Name:MCDOUGAL, SARAH NICOLE (RD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:NICOLE
Last Name:MCDOUGAL
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 1:17 CHESTER RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-1805
Mailing Address - Country:US
Mailing Address - Phone:860-575-7900
Mailing Address - Fax:
Practice Address - Street 1:17 CHESTER RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:CT
Practice Address - Zip Code:06612-1805
Practice Address - Country:US
Practice Address - Phone:860-575-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00984533133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered