Healthcare Provider Details

I. General information

NPI: 1356293435
Provider Name (Legal Business Name): NEVAEH SANDOVAL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 MOUNTAIN ROAD PL NE
ALBUQUERQUE NM
87110-7845
US

IV. Provider business mailing address

1 KITAY CT
JACKSON NJ
08527-3957
US

V. Phone/Fax

Practice location:
  • Phone: 718-344-8623
  • Fax:
Mailing address:
  • Phone: 718-344-8623
  • Fax: 718-344-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: