Provider Demographics
NPI:1912347717
Name:OLIVERIO, SANDRA MINNICK (MS, RD, CD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MINNICK
Last Name:OLIVERIO
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 18TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5388
Mailing Address - Country:US
Mailing Address - Phone:812-375-0272
Mailing Address - Fax:812-375-1093
Practice Address - Street 1:2325 18TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5388
Practice Address - Country:US
Practice Address - Phone:812-375-0272
Practice Address - Fax:812-375-1093
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000553A133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal