Provider Demographics
NPI:1114782737
Name:SANDERS, TERRANCE LAMAR (PROVIDER)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:LAMAR
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PROVIDER
Other - Prefix:
Other - First Name:TERRANCE
Other - Middle Name:LAMAR
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TERRANCE L SANDERS
Mailing Address - Street 1:745 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1265
Mailing Address - Country:US
Mailing Address - Phone:937-244-7073
Mailing Address - Fax:
Practice Address - Street 1:745 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1265
Practice Address - Country:US
Practice Address - Phone:937-244-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1204806253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care