Provider Demographics
NPI:1164751996
Name:CHANG, SANDRA S (PA)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:S
Last Name:CHANG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 MIDSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1726
Mailing Address - Country:US
Mailing Address - Phone:512-791-7436
Mailing Address - Fax:
Practice Address - Street 1:2745 TOWN CENTER BLVD N UNIT 132
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2320
Practice Address - Country:US
Practice Address - Phone:832-478-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
N/AOtherN/A