Provider Demographics
NPI:1750913984
Name:FLEEGEL, SANDRA L (LPN)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:FLEEGEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:BESIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1504 JAKE ALEXANDER BLVD W
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-1213
Mailing Address - Country:US
Mailing Address - Phone:704-645-8539
Mailing Address - Fax:
Practice Address - Street 1:1504 JAKE ALEXANDER BLVD W
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1213
Practice Address - Country:US
Practice Address - Phone:704-645-8539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50146164W00000X
261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No164W00000XNursing Service ProvidersLicensed Practical Nurse