Provider Demographics
NPI:1841577608
Name:WYERS, SANDRA R (MS, RDN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:R
Last Name:WYERS
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 BANYON ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1506
Mailing Address - Country:US
Mailing Address - Phone:512-878-0464
Mailing Address - Fax:
Practice Address - Street 1:2900 W ANDERSON LN STE C-200354
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1102
Practice Address - Country:US
Practice Address - Phone:512-643-3761
Practice Address - Fax:737-282-0615
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2022-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133NN1002X
TXDT82734133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT82734OtherSTATE LICENSE
NMLD-0737OtherSTATE LICENSE
ORLD-D-000996OtherSTATE LICENSE