Provider Demographics
NPI:1356506208
Name:SANDLIN, SUSAN CAROL (LAC, MSOM)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CAROL
Last Name:SANDLIN
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 BILLINGSGATE CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4242
Mailing Address - Country:US
Mailing Address - Phone:804-437-1947
Mailing Address - Fax:804-740-0010
Practice Address - Street 1:1891 BILLINGSGATE CIR
Practice Address - Street 2:SUITE B
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4242
Practice Address - Country:US
Practice Address - Phone:804-437-1947
Practice Address - Fax:804-740-0010
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000218171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist