Provider Demographics
NPI:1124196969
Name:SAMPSON, SANDRA L (LIC AC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ACUPUNCTURE ALLIANCE
Mailing Address - Street 2:7 LINCOLN STREET - SUITE 316
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880
Mailing Address - Country:US
Mailing Address - Phone:781-246-2957
Mailing Address - Fax:
Practice Address - Street 1:ACUPUNCTURE ALLIANCE
Practice Address - Street 2:7 LINCOLN STREET - SUITE 316
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01881
Practice Address - Country:US
Practice Address - Phone:781-246-2957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist