MEDICARE: GRACE SANDRI

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	104100000X	Social Worker	6851120628	MI

General Provider Information

NPI Number	:	1548125073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE SANDRI

Provider Business Mailing Address
First Line	:	23754 MEDINA ST
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48035-1925
Country	:	US
Telephone Number	:	586-335-9093
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 PARKLAND BLVD
Second Line	:	SUITE E200
City	:	DEARBORN
State	:	MI
Zip	:	48126
Country	:	US
Telephone Number	:	313-846-2606
Fax Number	:

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

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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Directions to “ GRACE SANDRI ” Practice Location

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