Provider Demographics
NPI:1427304005
Name:SWEAT, SANDRA E (MPH,LD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:SWEAT
Suffix:
Gender:F
Credentials:MPH,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 S BONHAM ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-2139
Mailing Address - Country:US
Mailing Address - Phone:806-352-1517
Mailing Address - Fax:806-373-9446
Practice Address - Street 1:2205 S BONHAM ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-2139
Practice Address - Country:US
Practice Address - Phone:806-352-1517
Practice Address - Fax:806-373-9446
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT00519133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered