Healthcare Provider Details

I. General information

NPI: 1972733483
Provider Name (Legal Business Name): SARAH BUTLER MAZERALL MBA, MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH CHRISTINE BUTLER MBA, MS, RD, LDN

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BROOKLINE AVE
BOSTON MA
02215-3904
US

IV. Provider business mailing address

133 BROOKLINE AVE
BOSTON MA
02215-3904
US

V. Phone/Fax

Practice location:
  • Phone: 617-629-6444
  • Fax: 617-629-6070
Mailing address:
  • Phone: 617-629-6444
  • Fax: 617-629-6070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2734
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: