Provider Demographics
NPI:1831740794
Name:SINGH, SANDEEP KAUR (NP)
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:KAUR
Last Name:SINGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:AL
Mailing Address - Zip Code:36274-8114
Mailing Address - Country:US
Mailing Address - Phone:334-863-0088
Mailing Address - Fax:
Practice Address - Street 1:1495 LAFAYETTE PKWY
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-2552
Practice Address - Country:US
Practice Address - Phone:706-884-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF06191519363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care