Provider Demographics
NPI:1417133257
Name:DAVIS, SANDRA (AUD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:840 N ELDRIDGE PKWY
Mailing Address - Street 2:180
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2704
Mailing Address - Country:US
Mailing Address - Phone:281-497-9001
Mailing Address - Fax:281-497-3408
Practice Address - Street 1:840 N ELDRIDGE PKWY
Practice Address - Street 2:180
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2704
Practice Address - Country:US
Practice Address - Phone:281-497-9001
Practice Address - Fax:281-497-3408
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6535237700000X
TX80655174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1417133257OtherNPHI