MEDICARE: MICHAEL SANDERS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TA0700X	Adult Development & Aging Psychologist
2	103TH0100X	Health Service Psychologist
3	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1245066638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SANDERS

Provider Business Mailing Address
First Line	:	16 MILTON ST STE 6
Second Line	:
City	:	DEDHAM
State	:	MA
Zip	:	02026-2991
Country	:	US
Telephone Number	:	888-955-1167
Fax Number	:	888-245-9392

Provider Business Practice Location Address
First Line	:	16 MILTON ST STE 6
Second Line	:
City	:	DEDHAM
State	:	MA
Zip	:	02026-2991
Country	:	US
Telephone Number	:	888-955-1167
Fax Number	:	888-245-9392

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

Provider Enumeration Date	:	09/11/2024
Last Update Date	:	09/11/2024

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Directions to “ MICHAEL SANDERS ” Practice Location

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