Provider Demographics
NPI:1275252504
Name:CRISCUOLO, SARAH (MS, RD, LDN, CSN,CPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:CRISCUOLO
Suffix:
Gender:F
Credentials:MS, RD, LDN, CSN,CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 LEXINGTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8303
Mailing Address - Country:US
Mailing Address - Phone:860-759-0686
Mailing Address - Fax:
Practice Address - Street 1:100 MORSE ST STE 212
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4679
Practice Address - Country:US
Practice Address - Phone:781-269-1623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5660133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered