Provider Demographics
NPI:1235477167
Name:SANDOVAL, DAFFNEY LAUREN
Entity Type:Individual
Prefix:
First Name:DAFFNEY
Middle Name:LAUREN
Last Name:SANDOVAL
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 1:701 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-1660
Mailing Address - Country:US
Mailing Address - Phone:307-760-3561
Mailing Address - Fax:
Practice Address - Street 1:701 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-1660
Practice Address - Country:US
Practice Address - Phone:307-760-3561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker