Healthcare Provider Details

I. General information

NPI: 1275321135
Provider Name (Legal Business Name): KIMBERLY SANDOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 DECATUR BLVD
INDIANAPOLIS IN
46241-9561
US

IV. Provider business mailing address

639 E 56TH ST
INDIANAPOLIS IN
46220-3133
US

V. Phone/Fax

Practice location:
  • Phone: 317-856-5201
  • Fax:
Mailing address:
  • Phone: 574-551-4176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007754A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: