Provider Demographics
NPI:1134090160
Name:BOEHM, SARAH KALESSE (MS, RDN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KALESSE
Last Name:BOEHM
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 CHATSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-1867
Mailing Address - Country:US
Mailing Address - Phone:215-850-3927
Mailing Address - Fax:
Practice Address - Street 1:628 CHATSWORTH DR
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-1867
Practice Address - Country:US
Practice Address - Phone:215-850-3927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN009243133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered