Provider Demographics
NPI:1235343427
Name:BRASSARD, SANDRA G (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:G
Last Name:BRASSARD
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HIGHPOINT CT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-1629
Mailing Address - Country:US
Mailing Address - Phone:912-429-5898
Mailing Address - Fax:
Practice Address - Street 1:8 HIGHPOINT CT
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-1629
Practice Address - Country:US
Practice Address - Phone:912-429-5898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001647163WD0400X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA521627205AMedicaid
GAP00853752OtherRR MEDICARE
GA01383102OtherAMERIGROUP
GA01383102OtherAMERIGROUP