Healthcare Provider Details

I. General information

NPI: 1194045955
Provider Name (Legal Business Name): SANDRA LOUISE LYNCH M.S., R.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 BALTIMORE NATIONAL PIKE
MYERSVILLE MD
21773-8143
US

IV. Provider business mailing address

9305 BALTIMORE NATIONAL PIKE
MYERSVILLE MD
21773-8143
US

V. Phone/Fax

Practice location:
  • Phone: 240-439-9927
  • Fax: 301-371-5858
Mailing address:
  • Phone: 240-439-9927
  • Fax: 301-371-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD01147
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: