Provider Demographics
NPI:1588011308
Name:SANDY, SARAH (MNT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SANDY
Suffix:
Gender:F
Credentials:MNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 CONIFER CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1523
Mailing Address - Country:US
Mailing Address - Phone:303-656-3847
Mailing Address - Fax:
Practice Address - Street 1:3600 CONIFER CT
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1523
Practice Address - Country:US
Practice Address - Phone:303-656-3847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-22
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist