Provider Demographics
NPI:1093819351
Name:MORENO-HUSSEY, SANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:MORENO-HUSSEY
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 1:838 WEST MEETING STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720
Mailing Address - Country:US
Mailing Address - Phone:803-416-5295
Mailing Address - Fax:803-416-5240
Practice Address - Street 1:838 WEST MEETING STREET
Practice Address - Street 2:SUITE A
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720
Practice Address - Country:US
Practice Address - Phone:803-416-5295
Practice Address - Fax:803-416-5240
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22890208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC228907Medicaid
SCH82047Medicare UPIN