Provider Demographics
NPI:1083846414
Name:SANDBACH, KAREN C (PHD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:C
Last Name:SANDBACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 748519
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8519
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-391-5394
Practice Address - Street 1:1650 PRUDENTIAL DR STE 210
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8149
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-396-4942
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1224103T00000X
VA0810004652103T00000X
FLPY 8871103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist