Provider Demographics
NPI:1487297149
Name:KEYES, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KEYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SOUTHSIDE DR STE 11-182
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3870
Mailing Address - Country:US
Mailing Address - Phone:518-930-2790
Mailing Address - Fax:
Practice Address - Street 1:129 SANDERS AVE
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-2227
Practice Address - Country:US
Practice Address - Phone:518-466-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered