Provider Demographics
NPI:1750392098
Name:SANDS, JAMES DANIEL (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DANIEL
Last Name:SANDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:SANDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:31 SEQUOIA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403
Mailing Address - Country:US
Mailing Address - Phone:707-526-8306
Mailing Address - Fax:707-526-8319
Practice Address - Street 1:31 SEQUOIA CIR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4988
Practice Address - Country:US
Practice Address - Phone:707-237-1675
Practice Address - Fax:707-581-2013
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12751103TC0700X, 103T00000X, 103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
0PL127510Medicare ID - Type Unspecified