Provider Demographics
NPI:1306181730
Name:DAWOOD, SANDRA CAROL (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:CAROL
Last Name:DAWOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:SHAW
Other - Last Name:DAWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:850 KEYES AVE
Mailing Address - Street 2:
Mailing Address - City:ANGWIN
Mailing Address - State:CA
Mailing Address - Zip Code:94508-9625
Mailing Address - Country:US
Mailing Address - Phone:707-965-2673
Mailing Address - Fax:
Practice Address - Street 1:850 KEYES AVE
Practice Address - Street 2:
Practice Address - City:ANGWIN
Practice Address - State:CA
Practice Address - Zip Code:94508-9625
Practice Address - Country:US
Practice Address - Phone:707-965-2673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12011103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical