MEDICARE: MS. GRAYSON NICOLE SANDERS PA-C

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	363A00000X	Physician Assistant	PA.0007223	CO

General Provider Information

NPI Number	:	1528715604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GRAYSON NICOLE SANDERS PA-C

Provider Business Mailing Address
First Line	:	6226 SIERRA GRANDE PT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3871
Country	:	US
Telephone Number	:	334-389-2338
Fax Number	:

Provider Business Practice Location Address
First Line	:	6566 N MARKSHEFFEL RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-4252
Country	:	US
Telephone Number	:	719-297-7646
Fax Number	:

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

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/08/2022

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