Provider Demographics
NPI:1134997026
Name:AUSTIN, SANDRA M
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:AUSTIN
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 1:66 WHITTIER DR
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05866-9704
Mailing Address - Country:US
Mailing Address - Phone:802-535-2963
Mailing Address - Fax:
Practice Address - Street 1:2225 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-8635
Practice Address - Country:US
Practice Address - Phone:802-748-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist