Provider Demographics
NPI:1376144394
Name:SANDERS, TAMMY C
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:C
Last Name:SANDERS
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 1:14604 REDDINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3218
Mailing Address - Country:US
Mailing Address - Phone:216-246-8503
Mailing Address - Fax:
Practice Address - Street 1:14604 REDDINGTON AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3218
Practice Address - Country:US
Practice Address - Phone:216-246-8503
Practice Address - Fax:216-421-1817
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1823585OtherINDEPENDANT PROVIDER