Healthcare Provider Details

I. General information

NPI: 1730166968
Provider Name (Legal Business Name): SANDRA J. SAILORS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA J. HALLER M.D.

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST. 3 FL / ANESTHESIA DEPT
DAYTON OH
45409
US

IV. Provider business mailing address

P.O. BOX 632317
CINCINNATI OH
45263-2317
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-4380
  • Fax: 937-208-3843
Mailing address:
  • Phone: 937-208-7288
  • Fax: 937-208-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35068980
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.072370
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: