Provider Demographics
NPI:1184753717
Name:GALLO, SANDRA E (CFNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:GALLO
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 NIXON DR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-5823
Mailing Address - Country:US
Mailing Address - Phone:623-640-8270
Mailing Address - Fax:
Practice Address - Street 1:6051 FM 3009 STE 210
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-3473
Practice Address - Country:US
Practice Address - Phone:210-299-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142586363LF0000X
AZAP2079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ130322Medicaid