Healthcare Provider Details

I. General information

NPI: 1386553709
Provider Name (Legal Business Name): SHAGUFTA SANDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8435 ARCHIBALD AVE
RANCHO CUCAMONGA CA
91730-3662
US

IV. Provider business mailing address

750 S LINCOLN AVE # 104-382
CORONA CA
92882-3551
US

V. Phone/Fax

Practice location:
  • Phone: 909-484-1337
  • Fax: 909-980-1184
Mailing address:
  • Phone: 909-484-1337
  • Fax: 909-980-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: