MEDICARE: SANDY L SIAN

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	237600000X	Audiologist-Hearing Aid Fitter		MI
2	237700000X	Hearing Instrument Specialist	3501004909	MI

General Provider Information

NPI Number	:	1265697320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDY L SIAN

Provider Business Mailing Address
First Line	:	PO BOX 406153
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-1876
Country	:	US
Telephone Number	:	561-478-8770
Fax Number	:	561-688-8877

Provider Business Practice Location Address
First Line	:	4301 CANAL AVE SW
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-2667
Country	:	US
Telephone Number	:	616-257-7880
Fax Number	:	616-257-0580

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

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	09/09/2009

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Directions to “ SANDY L SIAN ” Practice Location

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