Provider Demographics
NPI:1891736187
Name:MINIX, SANDRA GAY (RD, CD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:GAY
Last Name:MINIX
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:GAY
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD
Mailing Address - Street 1:600 EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2483
Mailing Address - Country:US
Mailing Address - Phone:574-524-7474
Mailing Address - Fax:
Practice Address - Street 1:600 EAST BLVD
Practice Address - Street 2:DEPT OF NUTRITION
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2483
Practice Address - Country:US
Practice Address - Phone:574-524-7474
Practice Address - Fax:574-296-6504
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002665133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALD002665OtherLICENSED DIETITIAN