Provider Demographics
NPI:1376566968
Name:LEE, SANDRA L (PA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 E HERNDON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2907
Mailing Address - Country:US
Mailing Address - Phone:559-432-8300
Mailing Address - Fax:559-432-9083
Practice Address - Street 1:540 E HERNDON AVE STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2907
Practice Address - Country:US
Practice Address - Phone:559-432-8300
Practice Address - Fax:559-432-9083
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17987363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA179870Medicare ID - Type Unspecified
OPA179871Medicare PIN
CAQ61859Medicare UPIN