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NPI Code Detail

MEDICARE: MS. BRENDA S SANDERS M.A.

MEDICARE: MS. BRENDA S SANDERS M.A.
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
1103TC0700XClinical Psychologist6361006021MI

General Provider Information

NPI Number : 1366451395
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BRENDA S SANDERS M.A.
Provider Business Mailing Address
First Line : 1040 W BRISTOL RD
Second Line :
City : FLINT
State : MI
Zip : 48507-5516
Country : US
Telephone Number : 810-257-3705
Fax Number :
Provider Business Practice Location Address
First Line : 1040 W BRISTOL RD
Second Line :
City : FLINT
State : MI
Zip : 48507-5516
Country : US
Telephone Number : 810-257-3705
Fax Number : 810-496-5344
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2006
Last Update Date : 11/26/2024

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