Provider Demographics
NPI:1558088294
Name:PERRAULT, MAEGAN (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:MAEGAN
Middle Name:
Last Name:PERRAULT
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1507
Mailing Address - Country:US
Mailing Address - Phone:207-358-9887
Mailing Address - Fax:
Practice Address - Street 1:144 THADEUS ST STE 1
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6259
Practice Address - Country:US
Practice Address - Phone:207-358-9887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1794133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered