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NPI Code Detail

MEDICARE: MS. SANDRA LYNN ABDULLAH LCSW

MEDICARE: MS. SANDRA LYNN ABDULLAH LCSW
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
11041C0700XClinical Social Worker2859-CNV
21041C0700XClinical Social Worker149005598IL

Other Identifiers

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

General Provider Information

NPI Number : 1265524649
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SANDRA LYNN ABDULLAH LCSW
Provider Business Mailing Address
First Line : 386 SANCTUARY CT
Second Line :
City : HENDERSON
State : NV
Zip : 89014-4588
Country : US
Telephone Number : 702-431-0167
Fax Number : 702-547-0606
Provider Business Practice Location Address
First Line : 1799 MOUNT MARIAH DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-1501
Country : US
Telephone Number : 702-209-9918
Fax Number : 702-307-5421
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2006
Last Update Date : 05/06/2015

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