Provider Demographics
NPI:1588613723
Name:SANDERS-BANUELAS, ANGELA GALE (PA - C)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:GALE
Last Name:SANDERS-BANUELAS
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:GALE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4461 COIT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0522
Mailing Address - Country:US
Mailing Address - Phone:214-497-5223
Mailing Address - Fax:972-335-7560
Practice Address - Street 1:4461 COIT RD STE 101
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0522
Practice Address - Country:US
Practice Address - Phone:972-335-8455
Practice Address - Fax:972-335-7560
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04356363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8E0376OtherMEDICARE RAILROAD NUMBER
TX8E0386Medicare PIN
Q40955Medicare UPIN