Healthcare Provider Details

I. General information

NPI: 1780879130
Provider Name (Legal Business Name): SANDRA RACHAL RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S PATTERSON BLVD STE #210
DAYTON OH
45402-2684
US

IV. Provider business mailing address

1222 S PATTERSON BLVD STE #210
DAYTON OH
45402-2684
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-9090
  • Fax: 937-208-9075
Mailing address:
  • Phone: 937-208-9090
  • Fax: 937-208-9075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberLD.1250
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: