Provider Demographics
NPI:1093592552
Name:DAREUS, SANDRA V
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:V
Last Name:DAREUS
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 1:45 BOYNTON AVE SE UNIT 1207
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-1868
Mailing Address - Country:US
Mailing Address - Phone:215-439-9519
Mailing Address - Fax:
Practice Address - Street 1:285 W WIEUCA RD NE
Practice Address - Street 2:PMB 4096
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3321
Practice Address - Country:US
Practice Address - Phone:215-439-9519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics