Healthcare Provider Details

I. General information

NPI: 1912811860
Provider Name (Legal Business Name): DESTINY SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 SAGEBRIAR DR
BRYAN TX
77802-6107
US

IV. Provider business mailing address

401 UNIVERSITY OAKS BLVD APT 1407
COLLEGE STATION TX
77840-3405
US

V. Phone/Fax

Practice location:
  • Phone: 210-598-7253
  • Fax:
Mailing address:
  • Phone: 903-216-5069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: