Provider Demographics
NPI:1922670660
Name:HEIL, SANDRA M (RDN, LD, MPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:HEIL
Suffix:
Gender:F
Credentials:RDN, LD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 DERBY LN
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-7080
Mailing Address - Country:US
Mailing Address - Phone:952-201-8946
Mailing Address - Fax:
Practice Address - Street 1:7575 DERBY LN
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-7080
Practice Address - Country:US
Practice Address - Phone:952-201-8946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12260589-4901133V00000X
MN1152133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered