Provider Demographics
NPI:1700024023
Name:NAGATA, SANDI C (DPM)
Entity Type:Individual
Prefix:
First Name:SANDI
Middle Name:C
Last Name:NAGATA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 188TH ST SW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4716
Mailing Address - Country:US
Mailing Address - Phone:425-778-5666
Mailing Address - Fax:425-771-5374
Practice Address - Street 1:3500 188TH ST SW
Practice Address - Street 2:SUITE 110
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4716
Practice Address - Country:US
Practice Address - Phone:425-778-5666
Practice Address - Fax:425-771-5374
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4926213ES0103X
PASC005993213ES0103X
MDLL9523213ES0103X
WAPO60335854213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGV494ZMedicare Oscar/Certification