Healthcare Provider Details

I. General information

NPI: 1740871037
Provider Name (Legal Business Name): SANDRA BELIZAIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OPC 2 BOX 60
APO AE
09094-9001
US

IV. Provider business mailing address

UNIT 3215 BOX MDG
APO AE
09094-3215
US

V. Phone/Fax

Practice location:
  • Phone: 423-999-5098
  • Fax:
Mailing address:
  • Phone: 63-714-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7401
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: