Provider Demographics
NPI:1043349343
Name:SANANGELO, SAMMY JR
Entity Type:Individual
Prefix:MR
First Name:SAMMY
Middle Name:
Last Name:SANANGELO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 JORDAN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4660
Mailing Address - Country:US
Mailing Address - Phone:318-425-5417
Mailing Address - Fax:318-221-1555
Practice Address - Street 1:701 JORDAN ST
Practice Address - Street 2:SUITE D
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4660
Practice Address - Country:US
Practice Address - Phone:318-425-5417
Practice Address - Fax:318-221-1555
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA446237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist