Provider Demographics
NPI:1093368060
Name:SANDERS, BRANDY
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 S WOODLAND DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-1740
Mailing Address - Country:US
Mailing Address - Phone:270-300-4517
Mailing Address - Fax:
Practice Address - Street 1:1345 S WOODLAND DR UNIT B
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-1740
Practice Address - Country:US
Practice Address - Phone:270-300-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator