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NPI Code Detail

MEDICARE: DR. SANDRA MARIE DERANEY REILLY PHD

MEDICARE: DR. SANDRA MARIE DERANEY REILLY 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
1103T00000XPsychologist2007CO

General Provider Information

NPI Number : 1598815722
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANDRA MARIE DERANEY REILLY PHD
Provider Business Mailing Address
First Line : 222 W MAGNOLIA ST
Second Line :
City : FORT COLLINS
State : CO
Zip : 80521-2812
Country : US
Telephone Number : 970-498-0560
Fax Number : 970-224-2126
Provider Business Practice Location Address
First Line : 222 W MAGNOLIA ST
Second Line :
City : FORT COLLINS
State : CO
Zip : 80521-2812
Country : US
Telephone Number : 970-498-0560
Fax Number : 970-224-2126
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2007
Last Update Date : 10/25/2018

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