Healthcare Provider Details

I. General information

NPI: 1093106981
Provider Name (Legal Business Name): SANDRA MCDERMOTT M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

IV. Provider business mailing address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

V. Phone/Fax

Practice location:
  • Phone: 252-847-8508
  • Fax: 252-847-1301
Mailing address:
  • Phone: 252-847-8508
  • Fax: 252-847-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number3114
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: