Provider Demographics
NPI:1760078026
Name:GRAHAM, SANDRA FAYE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:FAYE
Last Name:GRAHAM
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 1:3804 DELMORE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1810
Mailing Address - Country:US
Mailing Address - Phone:216-225-6287
Mailing Address - Fax:
Practice Address - Street 1:3804 DELMORE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44121-1810
Practice Address - Country:US
Practice Address - Phone:216-225-6287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker