Provider Demographics
NPI:1932468717
Name:SARTAIN, SANDRA LEE (LAC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:SARTAIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:LEE
Other - Last Name:SARTAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:6087 BEVERLYS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BROAD RUN
Mailing Address - State:VA
Mailing Address - Zip Code:20137-2308
Mailing Address - Country:US
Mailing Address - Phone:619-988-0339
Mailing Address - Fax:
Practice Address - Street 1:7643 LEESBURG PIKE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2530
Practice Address - Country:US
Practice Address - Phone:619-988-0339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000591171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist