Healthcare Provider Details

I. General information

NPI: 1568855815
Provider Name (Legal Business Name): WILLIAM SANDINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 CANAL ST
NEW ORLEANS LA
70119-6503
US

IV. Provider business mailing address

210 CORONADO DR
LULING LA
70070-2212
US

V. Phone/Fax

Practice location:
  • Phone: 844-239-3737
  • Fax:
Mailing address:
  • Phone: 504-812-9699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: