MEDICARE: MRS. SANDRA RENEE SCOTT-ROBERTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	NA08610037	TX

General Provider Information

NPI Number	:	1053924852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA RENEE SCOTT-ROBERTS

Provider Business Mailing Address
First Line	:	3131 SIMPSON STUART RD APT 2210
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-5066
Country	:	US
Telephone Number	:	214-298-0869
Fax Number	:

Provider Business Practice Location Address
First Line	:	8032 MEGAN WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-6625
Country	:	US
Telephone Number	:	214-298-0869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2020
Last Update Date	:	08/31/2020

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