Provider Demographics
NPI:1134895840
Name:LEE, SANDRA ESTELLE
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ESTELLE
Last Name:LEE
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 1:447 SOUTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-6721
Mailing Address - Country:US
Mailing Address - Phone:330-954-9441
Mailing Address - Fax:330-954-9441
Practice Address - Street 1:447 SOUTHAMPTON DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-6721
Practice Address - Country:US
Practice Address - Phone:330-954-9441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty