MEDICARE: MS. SUSAN CAROL SANDLIN L.AC, MSOM

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	171100000X	Acupuncturist	0121000218	VA

General Provider Information

NPI Number	:	1356506208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN CAROL SANDLIN L.AC, MSOM

Provider Business Mailing Address
First Line	:	1891 BILLINGSGATE CIR
Second Line	:	SUITE B
City	:	RICHMOND
State	:	VA
Zip	:	23238-4242
Country	:	US
Telephone Number	:	804-437-1947
Fax Number	:	804-740-0010

Provider Business Practice Location Address
First Line	:	1891 BILLINGSGATE CIR
Second Line	:	SUITE B
City	:	RICHMOND
State	:	VA
Zip	:	23238-4242
Country	:	US
Telephone Number	:	804-437-1947
Fax Number	:	804-740-0010

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

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	07/21/2008

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