Provider Demographics
NPI:1710713177
Name:SANFORD, ANGELA W (MS, RD, LD, CDCES)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:W
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MS, RD, LD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12450 CHEROKEE TRL
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-2689
Mailing Address - Country:US
Mailing Address - Phone:205-393-4801
Mailing Address - Fax:
Practice Address - Street 1:1800 MCFARLAND BLVD N STE 150
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2178
Practice Address - Country:US
Practice Address - Phone:205-759-1729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL739133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered