Provider Demographics
NPI:1467219527
Name:SANDERS, LENIESHA
Entity type:Individual
Prefix:
First Name:LENIESHA
Middle Name:
Last Name:SANDERS
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 1:390 40TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2633
Mailing Address - Country:US
Mailing Address - Phone:510-613-0330
Mailing Address - Fax:888-437-1193
Practice Address - Street 1:390 40TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2633
Practice Address - Country:US
Practice Address - Phone:510-613-0330
Practice Address - Fax:888-437-1193
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-06-16
Deactivation Date:2024-04-23
Deactivation Code:
Reactivation Date:2024-05-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No175T00000XOther Service ProvidersPeer Specialist