Provider Demographics
NPI:1528035508
Name:SANDMANN-UY, SUSAN F (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:F
Last Name:SANDMANN-UY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:F
Other - Last Name:SANDMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2702 NORTH 3RD STREET
Mailing Address - Street 2:SUITE 4020
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4608
Mailing Address - Country:US
Mailing Address - Phone:602-323-3344
Mailing Address - Fax:602-323-3496
Practice Address - Street 1:1492 SOUTH MILL AVENUE
Practice Address - Street 2:SUITE 312
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5676
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:480-927-1092
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ971350Medicaid
Z105629Medicare PIN
AZ971350Medicaid
H68723Medicare UPIN