Provider Demographics
NPI:1366693277
Name:JEFFERSON, SANDRA WYNEE (RD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:WYNEE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 S ASPEN ST STOP 89
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9562
Mailing Address - Country:US
Mailing Address - Phone:720-847-6585
Mailing Address - Fax:720-847-6494
Practice Address - Street 1:275 SOUTH ASPEN STREET STOP 89
Practice Address - Street 2:
Practice Address - City:BUCKLEY AFB
Practice Address - State:CO
Practice Address - Zip Code:80011-9547
Practice Address - Country:US
Practice Address - Phone:720-847-6485
Practice Address - Fax:720-847-6494
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA713252133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered