Provider Demographics
NPI:1386205342
Name:DE LEON ADAMES, SANDY
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:DE LEON ADAMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 HARTL DR
Mailing Address - Street 2:
Mailing Address - City:VERNON ROCKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5218
Mailing Address - Country:US
Mailing Address - Phone:860-609-1581
Mailing Address - Fax:
Practice Address - Street 1:77 HARTL DR
Practice Address - Street 2:
Practice Address - City:VERNON ROCKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06066-5218
Practice Address - Country:US
Practice Address - Phone:860-609-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver