MEDICARE: STEPHANIE SUZANNE SANCHEZ AUD

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	231H00000X	Audiologist	3118	NM

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	:	1225018872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SUZANNE SANCHEZ AUD

Provider Business Mailing Address
First Line	:	PO BOX 398
Second Line	:
City	:	JARALES
State	:	NM
Zip	:	87023-0398
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 MONTGOMERY BLVD NE
Second Line	:	STE. 215
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2501
Country	:	US
Telephone Number	:	505-247-4224
Fax Number	:	505-247-1772

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	02/10/2012

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