Provider Demographics
NPI:1578984019
Name:SANCHEZ, MISTI MICHELLE (RD, LD, CSP)
Entity Type:Individual
Prefix:MRS
First Name:MISTI
Middle Name:MICHELLE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:RD, LD, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 ROUND TOWER LN
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-5412
Mailing Address - Country:US
Mailing Address - Phone:409-719-8820
Mailing Address - Fax:
Practice Address - Street 1:2830 ROUND TOWER LN
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-5412
Practice Address - Country:US
Practice Address - Phone:409-719-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83071133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
1045255OtherCOMMISSION ON DIETETIC REGISTRATION