Provider Demographics
NPI:1063495034
Name:GUIDRY, SANDRA ABREU (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ABREU
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:MD
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 2417
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-2417
Mailing Address - Country:US
Mailing Address - Phone:307-638-0300
Mailing Address - Fax:307-638-0394
Practice Address - Street 1:214 E 23RD ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3748
Practice Address - Country:US
Practice Address - Phone:307-638-0300
Practice Address - Fax:307-638-0394
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6074A207R00000X
CODR.0050547207R00000X
WA60363615207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY4205698OtherSUBSTANCE CONTROL
WY6074AOtherSTATE LICENSE
WY113165600Medicaid
COCOAAA3124Medicare PIN
WY113165600Medicaid
WY6074AOtherSTATE LICENSE
G32715Medicare UPIN