Provider Demographics
NPI:1346042231
Name:BENNETTI, SARAH ROSE (RDN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ROSE
Last Name:BENNETTI
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414-1411
Mailing Address - Country:US
Mailing Address - Phone:585-991-2050
Mailing Address - Fax:
Practice Address - Street 1:111 CLINTON ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NY
Practice Address - Zip Code:14414-1411
Practice Address - Country:US
Practice Address - Phone:585-991-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86099068133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered