1821092446 NPI number — SHARON R SANDELL MD

Table of content: SHARON R SANDELL MD (NPI 1821092446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821092446 NPI number — SHARON R SANDELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDELL
Provider First Name:
SHARON
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821092446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 515055
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75251-5055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-566-8340
Provider Business Mailing Address Fax Number:
972-566-8338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7777 FOREST LN
Provider Second Line Business Practice Location Address:
D569
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75230-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-566-8340
Provider Business Practice Location Address Fax Number:
972-566-8338
Provider Enumeration Date:
06/10/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0203X , with the licence number:  H4673 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100202530A . This is a "OKLAHOMA MEDICAID" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 8836M4 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 041814702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".