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General NPI Number Information
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NPI Number | 1386693042
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Entity Type | Individual
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Provider Name | SANDRA DEMEZZO RD, LD
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Gender | Female
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 452 CODY AVE SUITE 127 A
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City | HURLBURT FIELD
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State | FL
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Zip | 32544-5417
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Country | US
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Telephone | 850-884-4292
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Fax | 850-884-6321
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Provider Business Mailing Address
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Address Line | 113 LIELMANIS AVE 16 MDOS/SGOAZ
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City | HURLBURT FIELD
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State | FL
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Zip | 32544-5613
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Country | US
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Telephone | 850-622-2010
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Fax | 850-884-6321
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | ND 1859
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License Number State | FL
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