Provider Demographics
NPI:1609379734
Name:ALLEN, SANDI LYNN
Entity Type:Individual
Prefix:MRS
First Name:SANDI
Middle Name:LYNN
Last Name:ALLEN
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 1:3530 PLEASANTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-3920
Mailing Address - Country:US
Mailing Address - Phone:262-422-2508
Mailing Address - Fax:
Practice Address - Street 1:3530 PLEASANTVILLE RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-3920
Practice Address - Country:US
Practice Address - Phone:262-422-2508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant