Provider Information for 1861041204
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MELISSA ANN SANDFORD
Sex: Female
NPI: 1861041204
Last Updated: 2023-12-06
Certification Date: 2023-12-06
Certification Date: 2023-12-06
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1861041204 | ||||||||||||
| Enumeration Date | 2019-09-09 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 6401 ACADEMY RD NE APT 95 ALBUQUERQUE, NM 87109-3316 United States Phone: 505-234-9816 | Fax: | ||||||||||||
| Primary Practice Address | 5203 JUAN TABO BLVD NE ALBUQUERQUE, NM 87111-2683 United States Phone: 505-266-6121 | Fax: | ||||||||||||
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