Provider Demographics
NPI:1740556273
Name:SANDERS, AMITY MAY (RD)
Entity Type:Individual
Prefix:MRS
First Name:AMITY
Middle Name:MAY
Last Name:SANDERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 FAIRMONT DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4349
Mailing Address - Country:US
Mailing Address - Phone:850-252-0813
Mailing Address - Fax:850-913-8048
Practice Address - Street 1:2928 FAIRMONT DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4349
Practice Address - Country:US
Practice Address - Phone:850-252-0813
Practice Address - Fax:850-913-8048
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3325133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered