Provider Demographics
NPI:1932504636
Name:PEELER, SANDRA (CLTC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:PEELER
Suffix:
Gender:F
Credentials:CLTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513B 36TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-1309
Mailing Address - Country:US
Mailing Address - Phone:843-877-0450
Mailing Address - Fax:
Practice Address - Street 1:513B 36TH AVE N
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-1309
Practice Address - Country:US
Practice Address - Phone:843-877-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEA2478Medicaid