Healthcare Provider Details

I. General information

NPI: 1750436234
Provider Name (Legal Business Name): SANDRA S WHITTINGTON RD, CSP, LD N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 7TH AVE N
ST PETERSBURG FL
33701-2316
US

IV. Provider business mailing address

11600 IRVING AVE
SEMINOLE FL
33772-7002
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-3394
  • Fax:
Mailing address:
  • Phone: 727-393-1362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberND 451
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: