Healthcare Provider Details

I. General information

NPI: 1255924262
Provider Name (Legal Business Name): SANDRA HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 MACCORKLE AVE SW APT 123
SAINT ALBANS WV
25177-1697
US

IV. Provider business mailing address

571 MACCORKLE AVE SW APT 123
SAINT ALBANS WV
25177-1697
US

V. Phone/Fax

Practice location:
  • Phone: 614-302-5664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: