Healthcare Provider Details

I. General information

NPI: 1386892644
Provider Name (Legal Business Name): SANDRA K OSTERMEIER RD LD CN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA K O'SHEA

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GLENNS CREEK RD
FRANKFORT KY
40601-2473
US

IV. Provider business mailing address

100 GLENNS CREEK RD
FRANKFORT KY
40601-2473
US

V. Phone/Fax

Practice location:
  • Phone: 502-564-2585
  • Fax: 502-564-9640
Mailing address:
  • Phone: 502-564-2585
  • Fax: 502-564-9640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberKY-2056
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberKY-2056
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: