Provider Demographics
NPI:1376179382
Name:BLOME-DOWNEY, SANDRA (EDS)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BLOME-DOWNEY
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34121 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-8653
Mailing Address - Country:US
Mailing Address - Phone:248-931-5769
Mailing Address - Fax:
Practice Address - Street 1:34121 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-8653
Practice Address - Country:US
Practice Address - Phone:248-931-5769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-21
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO215610103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool