Provider Demographics
NPI:1447206206
Name:SANDERS, MINDY (MD)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3428
Mailing Address - Country:US
Mailing Address - Phone:518-449-2662
Mailing Address - Fax:518-449-1342
Practice Address - Street 1:760 MADISON AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3428
Practice Address - Country:US
Practice Address - Phone:518-449-2662
Practice Address - Fax:518-449-1342
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1211282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00390107Medicaid
NY00390107Medicaid
33710FMedicare ID - Type Unspecified