Provider Demographics
NPI:1942666037
Name:SOTNICK, SANDRA COLLEEN (MS, RDN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:COLLEEN
Last Name:SOTNICK
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:MRS
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:SOTNICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,RDN
Mailing Address - Street 1:741 SW 99TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:741 SW 99TH TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1009
Practice Address - Country:US
Practice Address - Phone:786-514-8044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND1119133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered