MEDICARE: DR. LYANNE SANDOVAL 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	8039	PR

General Provider Information

NPI Number	:	1548858061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYANNE SANDOVAL PHD

Provider Business Mailing Address
First Line	:	EDIFICIO OHARRIZ, D15 C. MCKINLEY
Second Line	:
City	:	MANATI
State	:	PR
Zip	:	00674
Country	:	US
Telephone Number	:	939-272-9707
Fax Number	:

Provider Business Practice Location Address
First Line	:	706 AVE ESCORIAL CAPARRA HEIGHTS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921
Country	:	US
Telephone Number	:	787-242-1649
Fax Number	:

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

Provider Enumeration Date	:	01/10/2021
Last Update Date	:	05/12/2026

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