Provider Demographics
NPI:1457517401
Name:CLEVELAND, SANDRA S (AUD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:S
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LEON STREET
Mailing Address - Street 2:503 BEHRAKIS HEALTH SCIENCES CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5000
Mailing Address - Country:US
Mailing Address - Phone:617-373-2496
Mailing Address - Fax:617-373-8756
Practice Address - Street 1:30 LEON STREET
Practice Address - Street 2:503 BEHRAKIS HEALTH SCIENCES CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5000
Practice Address - Country:US
Practice Address - Phone:617-373-2496
Practice Address - Fax:617-373-8756
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAD0072OtherBLUE CROSS BLUE SHIELD
MA5104416Medicaid
MAAD0072OtherBLUE CROSS BLUE SHIELD