Healthcare Provider Details

I. General information

NPI: 1811851553
Provider Name (Legal Business Name): MELISSA DIONNE SANDOVAL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25229 S SUN LAKES BLVD STE 119
SUN LAKES AZ
85248-6465
US

IV. Provider business mailing address

3948 W KIRKLAND AVE
SAN TAN VALLEY AZ
85144-6833
US

V. Phone/Fax

Practice location:
  • Phone: 602-332-7954
  • Fax:
Mailing address:
  • Phone: 602-332-7954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA011317
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: