Provider Demographics
NPI:1801275177
Name:CORDOVA, SANDRA (PSYD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W SHADOWBEND AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3970
Mailing Address - Country:US
Mailing Address - Phone:281-576-9343
Mailing Address - Fax:866-462-7454
Practice Address - Street 1:150 W SHADOWBEND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3968
Practice Address - Country:US
Practice Address - Phone:281-576-9343
Practice Address - Fax:866-462-7454
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36849103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist