Provider Demographics
NPI:1063247872
Name:MCDONALD-ROACH, SARAH JEANNE (RD)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JEANNE
Last Name:MCDONALD-ROACH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 LOCKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-2816
Mailing Address - Country:US
Mailing Address - Phone:413-222-3985
Mailing Address - Fax:
Practice Address - Street 1:175 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2389
Practice Address - Country:US
Practice Address - Phone:833-678-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86198176133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered