Healthcare Provider Details

I. General information

NPI: 1548081862
Provider Name (Legal Business Name): ALEEZA SANDHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3018 S JOPLIN AVE
TULSA OK
74114-6434
US

IV. Provider business mailing address

3018 S JOPLIN AVE
TULSA OK
74114-6434
US

V. Phone/Fax

Practice location:
  • Phone: 832-800-6689
  • Fax:
Mailing address:
  • Phone: 832-800-6689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number1005271
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: