Provider Demographics
NPI:1881187656
Name:SANDERS-SIMMONS, DADREAL
Entity Type:Individual
Prefix:MRS
First Name:DADREAL
Middle Name:
Last Name:SANDERS-SIMMONS
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 1:1265 BEL AIR DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1960
Mailing Address - Country:US
Mailing Address - Phone:225-235-5844
Mailing Address - Fax:
Practice Address - Street 1:3613 PERKINS RD STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-2946
Practice Address - Country:US
Practice Address - Phone:225-300-6398
Practice Address - Fax:225-300-6398
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist