Healthcare Provider Details

I. General information

NPI: 1255160586
Provider Name (Legal Business Name): MS. SANDRA ALSUP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721 TROUSDALE DR STE 206
NASHVILLE TN
37220-1372
US

IV. Provider business mailing address

2306 DUNDEE LN
NASHVILLE TN
37214-1520
US

V. Phone/Fax

Practice location:
  • Phone: 615-852-5955
  • Fax:
Mailing address:
  • Phone: 629-244-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1890
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: