Healthcare Provider Details

I. General information

NPI: 1497284608
Provider Name (Legal Business Name): SARAH BRICE KLAVERWEIDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date: 08/24/2021
Reactivation Date: 08/21/2023

III. Provider practice location address

301 BROOKVIEW DR
SALISBURY MD
21804-3907
US

IV. Provider business mailing address

301 BROOKVIEW DR
SALISBURY MD
21804-3907
US

V. Phone/Fax

Practice location:
  • Phone: 410-973-2371
  • Fax:
Mailing address:
  • Phone: 443-557-8411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX4436
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: