Provider Demographics
NPI:1023211950
Name:SANDERS, DORA BADEA (ITFS)
Entity Type:Individual
Prefix:MS
First Name:DORA
Middle Name:BADEA
Last Name:SANDERS
Suffix:
Gender:F
Credentials:ITFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1446
Mailing Address - Street 2:
Mailing Address - City:FOUR OAKS
Mailing Address - State:NC
Mailing Address - Zip Code:27524-1446
Mailing Address - Country:US
Mailing Address - Phone:919-963-6904
Mailing Address - Fax:
Practice Address - Street 1:105 COVE LANE
Practice Address - Street 2:
Practice Address - City:FOUR OAKS
Practice Address - State:NC
Practice Address - Zip Code:27524
Practice Address - Country:US
Practice Address - Phone:919-963-6904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist