Provider Demographics
NPI:1851371256
Name:YESNICK, SANDY Y (ORTL)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:Y
Last Name:YESNICK
Suffix:
Gender:F
Credentials:ORTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9191 W FLAMINGO RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6859
Mailing Address - Country:US
Mailing Address - Phone:702-966-2020
Mailing Address - Fax:702-966-2022
Practice Address - Street 1:9191 W FLAMINGO RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6859
Practice Address - Country:US
Practice Address - Phone:702-966-2020
Practice Address - Fax:702-966-2022
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100501807Medicaid
NV100501807Medicaid
NVV38336Medicare PIN