Provider Demographics
NPI:1013930197
Name:GAILEY, SANDRA LEE (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:GAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:VEDVICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-3942
Practice Address - Country:US
Practice Address - Phone:360-428-6434
Practice Address - Fax:360-848-4547
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5591207P00000X
WAMD60224794207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD40101Medicaid
AKMD40101Medicaid