Provider Demographics
NPI:1508992165
Name:FISHMAN, SANDRA JOY (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JOY
Last Name:FISHMAN
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 1:1402 FARR RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1714
Mailing Address - Country:US
Mailing Address - Phone:610-478-0228
Mailing Address - Fax:
Practice Address - Street 1:625 SPRING ST
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1770
Practice Address - Country:US
Practice Address - Phone:610-374-1944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002387133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA083758Medicare ID - Type UnspecifiedPROVIDER NUMBER