Provider Demographics
NPI:1619479847
Name:COUCH, SANDY RUTH
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:RUTH
Last Name:COUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:RUTH
Other - Last Name:MARCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:299 FAREHAM DR.
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-4477
Mailing Address - Country:US
Mailing Address - Phone:941-497-6516
Mailing Address - Fax:
Practice Address - Street 1:701 CENTER RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4808
Practice Address - Country:US
Practice Address - Phone:941-492-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-04
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator