Healthcare Provider Details

I. General information

NPI: 1740110956
Provider Name (Legal Business Name): KELLY ANN MUSCA SANDS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 CRINELLA DR
PETALUMA CA
94954-4499
US

IV. Provider business mailing address

PO BOX 181
POINT REYES STATION CA
94956-0181
US

V. Phone/Fax

Practice location:
  • Phone: 707-765-4321
  • Fax:
Mailing address:
  • Phone: 209-247-7044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: