MEDICARE: ANNIE NICOLE SANDERS PA-C

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	363A00000X	Physician Assistant	0010-13772	NC
2	363A00000X	Physician Assistant	030688	NY

General Provider Information

NPI Number	:	1740068717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE NICOLE SANDERS PA-C

Provider Business Mailing Address
First Line	:	7940 ANCON DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-0407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1341 WALTER REED RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4415
Country	:	US
Telephone Number	:	910-615-3500
Fax Number	:

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

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	02/03/2026

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Directions to “ ANNIE NICOLE SANDERS PA-C” Practice Location

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