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General NPI Number Information
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NPI Number | 1053924852
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Entity Type | Individual
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Provider Name | MRS. SANDRA RENEE SCOTT-ROBERTS
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Gender | Female
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 8032 MEGAN WAY
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City | DALLAS
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State | TX
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Zip | 75232-6625
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Country | US
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Telephone | 214-298-0869
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Fax |
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Provider Business Mailing Address
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Address Line | 3131 SIMPSON STUART RD APT 2210
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City | DALLAS
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State | TX
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Zip | 75241-5066
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Country | US
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Telephone | 214-298-0869
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | NA08610037
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License Number State | TX
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