Provider Demographics
NPI:1629054457
Name:CUNNINGHAM, SARAH (RD CDN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:KEARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD CDN
Mailing Address - Street 1:2 EXECUTIVE BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4164
Mailing Address - Country:US
Mailing Address - Phone:845-357-0166
Mailing Address - Fax:845-357-0249
Practice Address - Street 1:2 EXECUTIVE BLVD
Practice Address - Street 2:STE 203
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4164
Practice Address - Country:US
Practice Address - Phone:845-357-0166
Practice Address - Fax:845-357-0249
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005527-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered