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General NPI Number Information
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NPI Number | 1215153804
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Entity Type | Individual
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Provider Name | CRYSTAL SANDERSON RD, RDN
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 70 BUTLER ST
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City | SALEM
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State | NH
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Zip | 03079-3925
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Country | US
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Telephone | 603-893-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 158 GREAT ROAD, UNIT J PMB 11
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City | BEDFORD
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State | MA
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Zip | 01730
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Country | US
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Telephone | 206-949-0581
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00020117
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2254
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License Number State | NH
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