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General NPI Number Information
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NPI Number | 1548405707
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Entity Type | Individual
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Provider Name | SANDRA LEONA BLAKE AUD
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Gender | Female
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Dates
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Enumeration Date | 12/02/2008
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 11604 BUNNELL CT S
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City | POTOMAC
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State | MD
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Zip | 20854-3603
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Country | US
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Telephone | 301-299-6714
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Fax |
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Provider Business Mailing Address
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Address Line | 3857 PINE CONE CIRCLE
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City | WALDORF
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State | MD
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Zip | 20602
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Country | US
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Telephone | 301-299-6714
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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 | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 00139
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License Number State | MD
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