MEDICARE: SANDRA FAY CHAPIN

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	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1508413337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA FAY CHAPIN

Provider Business Mailing Address
First Line	:	1366 W CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7837
Country	:	US
Telephone Number	:	702-904-4966
Fax Number	:

Provider Business Practice Location Address
First Line	:	1366 W CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7837
Country	:	US
Telephone Number	:	702-904-4966
Fax Number	:

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

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	08/26/2019

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