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NPI Code Detail

MEDICARE: SANDRA L SHUYA PC

MEDICARE: SANDRA L SHUYA PC
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
1251S00000XCommunity/Behavioral Health AgencyCNP-02567NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11932478955OTHERTXNPI

General Provider Information

NPI Number : 1316339948
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANDRA L SHUYA PC
Provider Business Mailing Address
First Line : 1245 COUNTRY CLUB RD
Second Line : STE. 200
City : SANTA TERESA
State : NM
Zip : 88008-9743
Country : US
Telephone Number : 915-235-7676
Fax Number : 915-243-6006
Provider Business Practice Location Address
First Line : 1245 COUNTRY CLUB RD
Second Line : STE. 200
City : SANTA TERESA
State : NM
Zip : 88008-9743
Country : US
Telephone Number : 915-235-7676
Fax Number : 915-243-6006
Authorized Official
Title or Position : PRESIDENT
Name : SANDRA SHUYA
Credential : MSN
Telephone Number : 915-235-7676
Provider Enumeration Date : 02/18/2015
Last Update Date : 02/18/2015

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Directions to “SANDRA L SHUYA PC ” Practice Location

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