MEDICARE: SANDRA MILENA AMADO MEDINA M.D.

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	207Q00000X	Family Medicine Physician	Q5141	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114362985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MILENA AMADO MEDINA M.D.

Provider Business Mailing Address
First Line	:	26077 NELSON WAY
Second Line	:	STE 301
City	:	KATY
State	:	TX
Zip	:	77494-6677
Country	:	US
Telephone Number	:	832-228-2005
Fax Number	:

Provider Business Practice Location Address
First Line	:	26077 NELSON WAY
Second Line	:	SUITE 301
City	:	KATY
State	:	TX
Zip	:	77494-5642
Country	:	US
Telephone Number	:	832-882-5632
Fax Number	:	832-553-2686

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

Provider Enumeration Date	:	05/06/2013
Last Update Date	:	04/20/2022

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