Provider Demographics
NPI:1578219267
Name:SANDERS, ASHLEY JEANENE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JEANENE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1329
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-7329
Mailing Address - Country:US
Mailing Address - Phone:650-817-9070
Mailing Address - Fax:
Practice Address - Street 1:1692 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-5208
Practice Address - Country:US
Practice Address - Phone:650-817-9070
Practice Address - Fax:650-817-9074
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker