MEDICARE: SANDRA LOIS HAND RD, LDN, CNSD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1006X	Metabolic Nutrition Registered Dietitian	ND598	FL

General Provider Information

NPI Number	:	1396999207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA LOIS HAND RD, LDN, CNSD

Provider Business Mailing Address
First Line	:	8182 5TH STREET
Second Line	:
City	:	LAUREL HILL
State	:	FL
Zip	:	32567
Country	:	US
Telephone Number	:	850-652-2068
Fax Number	:	850-652-2068

Provider Business Practice Location Address
First Line	:	8182 5TH ST
Second Line	:
City	:	LAUREL HILL
State	:	FL
Zip	:	32567-2141
Country	:	US
Telephone Number	:	850-652-2068
Fax Number	:	850-652-2068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2008
Last Update Date	:	11/06/2008

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