Provider Demographics
NPI:1376143214
Name:MILES, SANDRA DENISE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DENISE
Last Name:MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 BAUX MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-2457
Mailing Address - Country:US
Mailing Address - Phone:336-995-5700
Mailing Address - Fax:
Practice Address - Street 1:4525 BAUX MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-2457
Practice Address - Country:US
Practice Address - Phone:336-995-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide