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General NPI Number Information
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NPI Number | 1154845626
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Entity Type | Individual
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Provider Name | SANDRA LEE
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Gender | Female
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Dates
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Enumeration Date | 07/27/2017
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Last Update Date | 07/27/2017
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Provider Practice Location Address
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Address Line | 4440 S EASTERN AVE
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City | LAS VEGAS
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State | NV
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Zip | 89119-7825
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Country | US
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Telephone | 702-476-0023
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Fax | 702-973-3477
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Provider Business Mailing Address
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Address Line | 3909 RICEBIRD WAY
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89084-2617
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Country | US
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Telephone | 702-336-5392
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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