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NPI Code Detail

MEDICARE: MRS. SANDRA L DUMAS

MEDICARE: MRS. SANDRA L DUMAS
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1114577830
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SANDRA L DUMAS
Provider Business Mailing Address
First Line : 130 CORRIDOR RD UNIT 3292
Second Line :
City : PONTE VEDRA BEACH
State : FL
Zip : 32004-7833
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1709 BUNKER HILL RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31907-6719
Country : US
Telephone Number : 706-315-0600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2019
Last Update Date : 09/14/2019

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Directions to “ MRS. SANDRA L DUMAS ” Practice Location

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