Provider Demographics
NPI:1609160043
Name:WOODRUFF, SANDRA LORRAINE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LORRAINE
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 LLOYDS COVE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-9688
Mailing Address - Country:US
Mailing Address - Phone:850-668-9925
Mailing Address - Fax:
Practice Address - Street 1:1431 LLOYDS COVE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-9688
Practice Address - Country:US
Practice Address - Phone:850-668-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND881133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered