MEDICARE: SANDRA HERNANDEZ B.S.,SLPA

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	2355S0801X	Speech-Language Assistant	2016020593	MO
2	235Z00000X	Speech-Language Pathologist	5579	OK

General Provider Information

NPI Number	:	1902309115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA HERNANDEZ B.S.,SLPA

Provider Business Mailing Address
First Line	:	4334 NW EXPRESSWAY STE 187
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1515
Country	:	US
Telephone Number	:	314-216-1966
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 NW 23RD ST STE 2D
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2420
Country	:	US
Telephone Number	:	405-355-3239
Fax Number	:

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

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	06/03/2021

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Directions to “ SANDRA HERNANDEZ B.S.,SLPA” Practice Location

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