Provider Demographics
NPI:1649826058
Name:POWERS, SARAH ALEXANDRA (RD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ALEXANDRA
Last Name:POWERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ALEXANDRA
Other - Last Name:CHURCHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:34 SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2437
Mailing Address - Country:US
Mailing Address - Phone:978-808-3366
Mailing Address - Fax:
Practice Address - Street 1:34 SALISBURY ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2437
Practice Address - Country:US
Practice Address - Phone:978-808-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3677133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered