Provider Demographics
NPI:1821788068
Name:CLAIRBORNE, SANDRA DENISE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DENISE
Last Name:CLAIRBORNE
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 1:4650 BLUEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-3337
Mailing Address - Country:US
Mailing Address - Phone:937-580-6830
Mailing Address - Fax:
Practice Address - Street 1:4650 BLUEHAVEN DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-3337
Practice Address - Country:US
Practice Address - Phone:937-580-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services