Provider Demographics
NPI:1477303832
Name:BERUBE, SARAH (RD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BERUBE
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 1:416 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3105
Mailing Address - Country:US
Mailing Address - Phone:315-541-2291
Mailing Address - Fax:
Practice Address - Street 1:416 RIVER RD
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3105
Practice Address - Country:US
Practice Address - Phone:315-541-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY513101133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty