Provider Demographics
NPI:1972733483
Name:MAZERALL, SARAH BUTLER (MBA, MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:BUTLER
Last Name:MAZERALL
Suffix:
Gender:F
Credentials:MBA, MS, RD, LDN
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:CHRISTINE
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBA, MS, RD, LDN
Mailing Address - Street 1:133 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3904
Mailing Address - Country:US
Mailing Address - Phone:617-629-6444
Mailing Address - Fax:617-629-6070
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-629-6444
Practice Address - Fax:617-629-6070
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2734133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered