Provider Demographics
NPI:1649214875
Name:GALLAGHER, SANDRA E (ARNP, CNM, DP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:ARNP, CNM, DP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-3202
Practice Address - Street 1:500 HEALTH BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1492
Practice Address - Country:US
Practice Address - Phone:386-252-5858
Practice Address - Fax:386-252-4477
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC285021367A00000X
FLARNP9293367367A00000X
AL1-102039367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051526075OtherBLUE CROSS
AL051526081OtherBLUE CROSS
AL569100070Medicaid
AL051526071OtherBLUE CROSS
AL051526073OtherBLUE CROSS
AL051526074OtherBLUE CROSS
AL051526080OtherBLUE CROSS
AL569100074Medicaid
AL051526077OtherBLUE CROSS
AL569100063Medicaid
AL569100068Medicaid
AL569100071Medicaid
AL051526079OtherBLUE CROSS
AL569100062Medicaid
AL051526070OtherBLUE CROSS
AL569100064Medicaid
AL569100067Medicaid
AL569100069Medicaid
AL569100065Medicaid
AL051526078OtherBLUE CROSS