Provider Demographics
NPI:1801404983
Name:BOUCHAMOUN, SARAH ROSE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ROSE
Last Name:BOUCHAMOUN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ROSE
Other - Last Name:FETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:1015 DEERFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-2473
Mailing Address - Country:US
Mailing Address - Phone:267-221-7960
Mailing Address - Fax:
Practice Address - Street 1:591 BRUNSWICK PIKE
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08530-2720
Practice Address - Country:US
Practice Address - Phone:267-221-7960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007006133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered