MEDICARE: BLUE SANDCASTLE LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1912850603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE SANDCASTLE LLC

Provider Business Mailing Address
First Line	:	215 N PAYNE ST STE 94521
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 N PAYNE ST STE 94521
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2444
Country	:	US
Telephone Number	:	469-915-5044
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	INGRID MARIE WISVEY
Credential	:
Telephone Number	:	469-915-5044

Provider Enumeration Date	:	02/20/2026
Last Update Date	:	02/20/2026

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Directions to “BLUE SANDCASTLE LLC ” Practice Location

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