Provider Demographics
NPI:1467412676
Name:YAUK, SANDRA (C PED)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:YAUK
Suffix:
Gender:F
Credentials:C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 COORS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2785
Mailing Address - Country:US
Mailing Address - Phone:505-896-0533
Mailing Address - Fax:505-896-0522
Practice Address - Street 1:6200 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2785
Practice Address - Country:US
Practice Address - Phone:505-896-0533
Practice Address - Fax:505-896-0522
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM06587577Medicaid
NMNM01TA20OtherBCBSNM
NM06928773Medicaid
NM5154880001Medicare NSC