Provider Demographics
NPI:1295966208
Name:ROBERTS, SANDRA D (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:D
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 LACOSTA DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5854
Mailing Address - Country:US
Mailing Address - Phone:609-653-4475
Mailing Address - Fax:
Practice Address - Street 1:408 E JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9706
Practice Address - Country:US
Practice Address - Phone:609-625-6947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2014-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ800038133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered