Provider Demographics
NPI:1265223192
Name:SANDEL, GENIEVA DESIRAE (PRS)
Entity type:Individual
Prefix:
First Name:GENIEVA
Middle Name:DESIRAE
Last Name:SANDEL
Suffix:
Gender:F
Credentials:PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1805
Mailing Address - Country:US
Mailing Address - Phone:234-376-9507
Mailing Address - Fax:
Practice Address - Street 1:515 SUMNER ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1771
Practice Address - Country:US
Practice Address - Phone:234-376-9507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.006374175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty