Provider Demographics
NPI:1497962377
Name:CHILDERS, SANDRA MARGARET (MT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARGARET
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:MARGARET
Other - Last Name:CADDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:4333 TURMERIC DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3958
Mailing Address - Country:US
Mailing Address - Phone:586-254-5951
Mailing Address - Fax:
Practice Address - Street 1:47100 SCHOENHERR RD STE E
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4714
Practice Address - Country:US
Practice Address - Phone:586-685-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist