Provider Demographics
NPI:1548349087
Name:KEELEY, SARAH N (RD)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:N
Last Name:KEELEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:B
Other - Last Name:NORTHROP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:12 ANDOVER ROAD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-761-5612
Mailing Address - Fax:207-253-6073
Practice Address - Street 1:12 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1954
Practice Address - Country:US
Practice Address - Phone:207-761-5612
Practice Address - Fax:207-253-6073
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI891133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000009602Medicare PIN