Provider Demographics
NPI:1780879130
Name:RACHAL, SANDRA (RD, LD, CDE)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:RACHAL
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 S PATTERSON BLVD
Mailing Address - Street 2:STE #210
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2684
Mailing Address - Country:US
Mailing Address - Phone:937-208-9090
Mailing Address - Fax:937-208-9075
Practice Address - Street 1:1222 S PATTERSON BLVD
Practice Address - Street 2:STE #210
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2684
Practice Address - Country:US
Practice Address - Phone:937-208-9090
Practice Address - Fax:937-208-9075
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.1250133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMT03891Medicare PIN