Active NPI
Angele Bodet Sandercock, RD LD CDCES
- Registered Dietitian
- Roswell, GA
National Provider Identifier
1841021789
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD002079
- Practice address
- 230 Oak Leaf Cir
Roswell, GA 30075-2105 - Phone
- (770) 377-8995
- NPI assigned
- Aug 12, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | LD002079 | GA | Primary |
Addresses
Primary practice location
230 Oak Leaf Cir
Roswell, GA 30075-2105
Mailing address
230 Oak Leaf Cir
Roswell, GA 30075-2105
Phone (770) 377-8995
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD002079 | GA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723420800000",
"number": "1841021789",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 OAK LEAF CIR",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300752105",
"telephone_number": "770-377-8995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 OAK LEAF CIR",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300752105",
"telephone_number": "770-377-8995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDERCOCK",
"first_name": "ANGELE",
"middle_name": "BODET",
"credential": "RD LD CDCES",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-12",
"last_updated": "2024-08-12",
"certification_date": "2024-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "LD002079",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roswell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.