MEDICARE: MR. JHYLON SANDERS I

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1598557076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JHYLON SANDERS I

Provider Business Mailing Address
First Line	:	222 RUE DE JEAN
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3388
Country	:	US
Telephone Number	:	337-456-7880
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 S COLLEGE RD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3212
Country	:	US
Telephone Number	:	337-417-9897
Fax Number	:

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

Provider Enumeration Date	:	05/20/2025
Last Update Date	:	05/28/2026

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