Healthcare Provider Details

I. General information

NPI: 1770375388
Provider Name (Legal Business Name): SANDRA CORINA SILVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 19TH ST UNIT B
ROSWELL NM
88201-7533
US

IV. Provider business mailing address

1855 SMARTY JONES ST SE
ALBUQUERQUE NM
87123-2398
US

V. Phone/Fax

Practice location:
  • Phone: 505-702-9080
  • Fax:
Mailing address:
  • Phone: 505-702-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB20240986
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: