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NPI Code Detail

MEDICARE: SANDRA E GRANBERRY MS

MEDICARE:   SANDRA E GRANBERRY  MS
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
1101YM0800XMental Health CounselorMH16115FL

General Provider Information

NPI Number : 1487214334
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA E GRANBERRY MS
Provider Business Mailing Address
First Line : 3451 RIVERINA DR
Second Line :
City : PENSACOLA
State : FL
Zip : 32514-8158
Country : US
Telephone Number : 850-462-1611
Fax Number : 850-462-1612
Provider Business Practice Location Address
First Line : 7100 PLANTATION RD STE 10
Second Line :
City : PENSACOLA
State : FL
Zip : 32504-6234
Country : US
Telephone Number : 850-462-1611
Fax Number : 850-462-1612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2019
Last Update Date : 06/13/2019

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Directions to “ SANDRA E GRANBERRY MS” Practice Location

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