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General NPI Number Information
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NPI Number | 1316339948
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Entity Type | Organization
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Legal Business Name | SANDRA L SHUYA PC
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 02/18/2015
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Provider Practice Location Address
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Address Line | 1245 COUNTRY CLUB RD STE. 200
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City | SANTA TERESA
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State | NM
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Zip | 88008-9743
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Country | US
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Telephone | 915-235-7676
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Fax | 915-243-6006
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Provider Business Mailing Address
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Address Line | 1245 COUNTRY CLUB RD STE. 200
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City | SANTA TERESA
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State | NM
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Zip | 88008-9743
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Country | US
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Telephone | 915-235-7676
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Fax | 915-243-6006
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANDRA SHUYA
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Credential | MSN
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Telephone | 915-235-7676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CNP-02567
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License Number State | NM
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