Provider Demographics
NPI:1760446488
Name:BURTON, SANDY M (RD)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:M
Last Name:BURTON
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:PO BOX 2357
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002
Mailing Address - Country:US
Mailing Address - Phone:270-444-9625
Mailing Address - Fax:270-575-5458
Practice Address - Street 1:916 KENTUCKY AVE
Practice Address - Street 2:PADUCAH-MCCRACKEN COUNTY HEALTH CENTER
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001
Practice Address - Country:US
Practice Address - Phone:270-444-9631
Practice Address - Fax:270-442-8769
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0985133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
0279207Medicare ID - Type Unspecified
0279607Medicare ID - Type Unspecified
0279807Medicare ID - Type Unspecified
0279307Medicare ID - Type Unspecified
0279407Medicare ID - Type Unspecified
2079707Medicare ID - Type Unspecified
0279507Medicare ID - Type Unspecified
Q02383Medicare UPIN
02224021Medicare ID - Type Unspecified