Provider Demographics
NPI:1215941307
Name:HASTINGS, SALLY CHAPMAN (MS,RD,LD/N)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:CHAPMAN
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:MS,RD,LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9033
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-9033
Mailing Address - Country:US
Mailing Address - Phone:772-223-5680
Mailing Address - Fax:772-223-5662
Practice Address - Street 1:501 SE OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2301
Practice Address - Country:US
Practice Address - Phone:772-223-5945
Practice Address - Fax:772-288-5871
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4345133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLND 4345OtherFL LICENSE