Provider Demographics
NPI:1538137807
Name:DIXON, SANDRA K (MPH, RD, LA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:DIXON
Suffix:
Gender:F
Credentials:MPH, RD, LA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3320
Mailing Address - Country:US
Mailing Address - Phone:352-540-6800
Mailing Address - Fax:
Practice Address - Street 1:300 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3320
Practice Address - Country:US
Practice Address - Phone:352-540-6800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 211133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P59099Medicare UPIN
FLE7376ZMedicare ID - Type Unspecified