Provider Demographics
NPI:1568664944
Name:SANDROW, CHERISA (DO)
Entity Type:Individual
Prefix:
First Name:CHERISA
Middle Name:
Last Name:SANDROW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16703 SE MCGILLIVRAY BLVD
Mailing Address - Street 2:STE 215
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4300
Mailing Address - Country:US
Mailing Address - Phone:360-883-2450
Mailing Address - Fax:866-935-1910
Practice Address - Street 1:16703 SE MCGILLIVRAY BLVD
Practice Address - Street 2:STE 215
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4300
Practice Address - Country:US
Practice Address - Phone:360-883-2450
Practice Address - Fax:866-935-1910
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60001820207Q00000X
ORDO174412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500610843Medicaid
WA8516643Medicaid
WAG8885985Medicare PIN