MEDICARE: DORA EMILSEN SANCHEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	41436	TX

General Provider Information

NPI Number	:	1063047157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORA EMILSEN SANCHEZ

Provider Business Mailing Address
First Line	:	19606 PARK ROW APT 215
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-6010
Country	:	US
Telephone Number	:	832-759-9386
Fax Number	:

Provider Business Practice Location Address
First Line	:	633 E FERNHUST DR
Second Line	:	UNIT 604
City	:	KATY
State	:	TX
Zip	:	77450-1589
Country	:	US
Telephone Number	:	832-980-7061
Fax Number	:	832-644-0127

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2020
Last Update Date	:	03/09/2020

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Directions to “ DORA EMILSEN SANCHEZ ” Practice Location

Language	Start Address	Practice Location

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