Provider Demographics
NPI:1194045955
Name:LYNCH, SANDRA LOUISE (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LOUISE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:MYERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21773-8143
Mailing Address - Country:US
Mailing Address - Phone:240-439-9927
Mailing Address - Fax:301-371-5858
Practice Address - Street 1:9305 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:MYERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21773-8143
Practice Address - Country:US
Practice Address - Phone:240-439-9927
Practice Address - Fax:301-371-5858
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01147133V00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator