Healthcare Provider Details

I. General information

NPI: 1962413633
Provider Name (Legal Business Name): SANDRA RELYEA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 E 8TH ST
PORT ANGELES WA
98362-6219
US

IV. Provider business mailing address

433 E 8TH ST
PORT ANGELES WA
98362-6219
US

V. Phone/Fax

Practice location:
  • Phone: 360-565-0999
  • Fax: 360-565-7635
Mailing address:
  • Phone: 360-565-0999
  • Fax: 360-565-7635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12880
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA608165855
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: