MEDICARE: DR. GAVIN DEREK SANDERS PHD

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	103TC0700X	Clinical Psychologist	40538	TX

General Provider Information

NPI Number	:	1396536132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAVIN DEREK SANDERS PHD

Provider Business Mailing Address
First Line	:	3796 VITRUVIAN WAY
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-4000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8330 LYNDON B JOHNSON FWY STE B555
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-1166
Country	:	US
Telephone Number	:	888-606-0086
Fax Number	:	346-223-0296

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

Provider Enumeration Date	:	05/13/2025
Last Update Date	:	04/07/2026

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