Individual
MRS. SANDRA LYNN AUDLEY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.S., R.D., L.D.
Contact information
Practice address
4514 BADER AVE, CLEVELAND, OH 44109-5266
(216) 832-1311
(216) 741-8705
Mailing address
4514 BADER AVE, CLEVELAND, OH 44109-5266
(216) 832-1311
(216) 741-8705
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
4532
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000379531
ANTHEM BLUE CROSS/SHIELD
OH
Enumeration date
12/29/2005
Last updated
07/08/2007
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