Provider Demographics
NPI:1437475381
Name:MANDANICI, SANDRA JEAN (MS RD CD-N)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JEAN
Last Name:MANDANICI
Suffix:
Gender:F
Credentials:MS RD CD-N
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:JEAN
Other - Last Name:NOVELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RD CD-N
Mailing Address - Street 1:2506 EATON CT
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-4065
Mailing Address - Country:US
Mailing Address - Phone:203-512-1282
Mailing Address - Fax:203-743-6633
Practice Address - Street 1:2506 EATON CT
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-4065
Practice Address - Country:US
Practice Address - Phone:203-512-1282
Practice Address - Fax:203-743-6633
Is Sole Proprietor?:No
Enumeration Date:2010-04-18
Last Update Date:2010-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000853133V00000X
NY006600133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered