Healthcare Provider Details

I. General information

NPI: 1770822850
Provider Name (Legal Business Name): SANDRA MARIE EDMOND MS,RD,CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 N. RURAL STREET 3RD FLOOR SUITE 300S MARION COUNTY PUBLIC HEALTH DEPARTMENT CHRONIC DISEASE
INDIANAPOLIS IN
46205-2930
US

IV. Provider business mailing address

3838 N. RURAL STREET 3RD FLOOR SUITE 300S MARION COUNTY PUBLIC HEALTH DEPARTMENT CHRONIC DISEASE
INDIANAPOLIS IN
46205-2930
US

V. Phone/Fax

Practice location:
  • Phone: 317-221-2098
  • Fax: 317-221-3114
Mailing address:
  • Phone: 317-221-2098
  • Fax: 317-221-3114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number634451
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: