Provider Demographics
NPI:1750436234
Name:WHITTINGTON, SANDRA S (RD, CSP, LD N)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:S
Last Name:WHITTINGTON
Suffix:
Gender:F
Credentials:RD, CSP, LD N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-7002
Mailing Address - Country:US
Mailing Address - Phone:727-393-1362
Mailing Address - Fax:
Practice Address - Street 1:500 7TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2316
Practice Address - Country:US
Practice Address - Phone:727-767-3394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLND 451133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric