Provider Demographics
NPI:1184386773
Name:SADLER, SANDIE CHANELLE
Entity type:Individual
Prefix:
First Name:SANDIE
Middle Name:CHANELLE
Last Name:SADLER
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 1:5852 S PECOS RD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3490
Mailing Address - Country:US
Mailing Address - Phone:702-268-7763
Mailing Address - Fax:
Practice Address - Street 1:1511 S CASINO CENTER BLVD # 501
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1109
Practice Address - Country:US
Practice Address - Phone:702-379-4287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant