Provider Demographics
NPI:1285824326
Name:GRAY, SANDRA S (LIC AC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:S
Last Name:GRAY
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 1:246 OLD ASHBY RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:NH
Mailing Address - Zip Code:03048-4630
Mailing Address - Country:US
Mailing Address - Phone:603-673-1303
Mailing Address - Fax:
Practice Address - Street 1:15 UNION ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4875
Practice Address - Country:US
Practice Address - Phone:603-673-1303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216128171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist