Provider Demographics
NPI:1710960331
Name:SWENBY, SANDRA MAE (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MAE
Last Name:SWENBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E PIONEER AVE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3265
Mailing Address - Country:US
Mailing Address - Phone:253-445-8120
Mailing Address - Fax:253-697-3730
Practice Address - Street 1:325 E. PIONEER AVE.
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372
Practice Address - Country:US
Practice Address - Phone:253-445-8120
Practice Address - Fax:253-697-3730
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010735542084P0800X
WAMD000480302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8494197Medicaid
MI4079420Medicaid
B55889Medicare UPIN
WAG8882467Medicare PIN
MI4079420Medicaid