Provider Demographics
NPI:1073592481
Name:GREENBLAT, SANDY (SLP)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:GREENBLAT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:VERRILLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2874 HICKORY RUN CIR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-7406
Mailing Address - Country:US
Mailing Address - Phone:404-993-5427
Mailing Address - Fax:470-588-9544
Practice Address - Street 1:22 BUFORD VILLAGE WAY STE 229
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8846
Practice Address - Country:US
Practice Address - Phone:678-482-6100
Practice Address - Fax:770-932-5684
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006142235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA715307105BMedicaid