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General NPI Number Information
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NPI Number | 1285595850
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Entity Type | Individual
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Provider Name | AMANDA ELYSSE SANDOVAL APRN-BC
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Gender | Female
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Dates
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Enumeration Date | 11/21/2025
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-1581
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Fax |
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Provider Business Mailing Address
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Address Line | 10985 S 84TH AVE APT 2B
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City | PALOS HILLS
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State | IL
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Zip | 60465-3232
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Country | US
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Telephone | 773-547-6311
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.033820
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License Number State | IL
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