Healthcare Provider Details

I. General information

NPI: 1306086590
Provider Name (Legal Business Name): SANDRA BRINKLEY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2954 WHEATLAND RD
FINCASTLE VA
24090-4361
US

IV. Provider business mailing address

2954 WHEATLAND RD
FINCASTLE VA
24090-4361
US

V. Phone/Fax

Practice location:
  • Phone: 540-354-7769
  • Fax:
Mailing address:
  • Phone: 540-354-7769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number811521
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: