Provider Demographics
NPI:1023072543
Name:WEST, SANDRA J (RD)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:J
Last Name:WEST
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 1:416 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-3115
Mailing Address - Country:US
Mailing Address - Phone:270-247-3553
Mailing Address - Fax:270-247-0391
Practice Address - Street 1:416 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-3115
Practice Address - Country:US
Practice Address - Phone:270-247-3553
Practice Address - Fax:270-247-0391
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1215133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q02383Medicare UPIN
0279309Medicare ID - Type Unspecified
0224023Medicare ID - Type Unspecified
0279209Medicare ID - Type Unspecified
0279609Medicare ID - Type Unspecified
0279509Medicare ID - Type Unspecified
0279409Medicare ID - Type Unspecified
0279709Medicare ID - Type Unspecified
0279809Medicare ID - Type Unspecified