Provider Demographics
NPI:1124371331
Name:SANDERS, LILA S (RD, LD)
Entity Type:Individual
Prefix:
First Name:LILA
Middle Name:S
Last Name:SANDERS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MIDTOWN PARK E
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4141
Mailing Address - Country:US
Mailing Address - Phone:251-478-2233
Mailing Address - Fax:251-478-2231
Practice Address - Street 1:2029B AIRPORT BLVD STE 195
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-1366
Practice Address - Country:US
Practice Address - Phone:251-478-2233
Practice Address - Fax:251-478-2231
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2021133V00000X
MSD1508133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered