Provider Demographics
NPI:1356319396
Name:SANCHEZ, CLYDE P (CFNP)
Entity Type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:P
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7236 DANCING EAGLE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1350
Mailing Address - Country:US
Mailing Address - Phone:505-292-1687
Mailing Address - Fax:
Practice Address - Street 1:7236 DANCING EAGLE AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1350
Practice Address - Country:US
Practice Address - Phone:505-292-1687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR15512363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT9809Medicaid
NM349349401Medicare ID - Type Unspecified
NMR13481Medicare UPIN