Provider Demographics
NPI:1689072852
Name:SANDERS, MARY BALDWIN (RD, LDN)
Entity Type:Individual
Prefix:PROF
First Name:MARY
Middle Name:BALDWIN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 ROSCOE LEWIS RD
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-6765
Mailing Address - Country:US
Mailing Address - Phone:282-400-7590
Mailing Address - Fax:828-227-7446
Practice Address - Street 1:1129 ROSCOE LEWIS RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-6765
Practice Address - Country:US
Practice Address - Phone:282-400-7590
Practice Address - Fax:828-227-7446
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002924133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered