Provider Demographics
NPI:1316026834
Name:HENSLEY, SANDRA KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:KAY
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 PLANTATION CT
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-9172
Mailing Address - Country:US
Mailing Address - Phone:812-246-3466
Mailing Address - Fax:812-246-0710
Practice Address - Street 1:485 N INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1224
Practice Address - Country:US
Practice Address - Phone:812-246-0705
Practice Address - Fax:812-246-0710
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043740208000000X
KY29708208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200078910Medicaid