MEDICARE: SANDRA AJAO

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1236073	TX

General Provider Information

NPI Number	:	1629902655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA AJAO

Provider Business Mailing Address
First Line	:	3016 AQUEDUCT AVE
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-2449
Country	:	US
Telephone Number	:	412-853-7909
Fax Number	:

Provider Business Practice Location Address
First Line	:	3016 AQUEDUCT AVE
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-2449
Country	:	US
Telephone Number	:	412-853-7909
Fax Number	:

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

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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