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General NPI Number Information
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NPI Number | 1720692494
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Entity Type | Individual
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Provider Name | MEMPHIS CHARDELL SANDOVAL PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 3203 DOGWOOD LN
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City | CARMEL
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State | IN
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Zip | 46032-9629
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Country | US
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Telephone | 317-498-1171
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Fax | 317-219-0879
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Provider Business Mailing Address
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Address Line | PO BOX 523882 C/O THE MAILBOX #10649
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City | MIAMI
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State | FL
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Zip | 33152-3882
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Country | US
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Telephone | 317-498-1171
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Fax | 317-219-0879
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704299093
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704299093
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 863235
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71014109A
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License Number State | IN
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