MEDICARE: DR. SUSAN LEE SANDERS DNP, FNP-C, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	PENDING	AZ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71003500A	IN
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024184018	VA
4	363LF0000X	Family Nurse Practitioner	71003500A	IN

General Provider Information

NPI Number	:	1093019952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN LEE SANDERS DNP, FNP-C, PMHNP-BC

Provider Business Mailing Address
First Line	:	8285 S FIREFLY DR
Second Line	:
City	:	PENDLETON
State	:	IN
Zip	:	46064-9296
Country	:	US
Telephone Number	:	765-610-5006
Fax Number	:	626-666-6731

Provider Business Practice Location Address
First Line	:	550 FIRST COLONIAL RD STE 308-4651
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6186
Country	:	US
Telephone Number	:	765-610-5006
Fax Number	:	623-666-6731

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

Provider Enumeration Date	:	01/06/2011
Last Update Date	:	09/02/2025

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