Provider Demographics
NPI:1952688830
Name:DURAND, SAMANDA (DO)
Entity Type:Individual
Prefix:
First Name:SAMANDA
Middle Name:
Last Name:DURAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 HARVARD WAY # T5
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2055
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-4595
Practice Address - Street 1:661 SIERRA ROSE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511
Practice Address - Country:US
Practice Address - Phone:775-982-8255
Practice Address - Fax:775-982-8251
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1912171100000X, 207R00000X
TXBP100033437207R00000X
PAOS016598207R00000X
TXP1747207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1952688830Medicaid
12580041OtherCAQH
NV1952688830Medicaid