MEDICARE: STEPHANIE M SANDERSON MD

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	208000000X	Pediatrics Physician	33928	TN

General Provider Information

NPI Number	:	1902870231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE M SANDERSON MD

Provider Business Mailing Address
First Line	:	1060 PEERLESS XING NW STE 100
Second Line	:	PEERLESS PEDIATRICS
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3785
Country	:	US
Telephone Number	:	423-339-5656
Fax Number	:	423-339-8889

Provider Business Practice Location Address
First Line	:	1060 PEERLESS XING, NW #100
Second Line	:	PEERLESS PEDIATRICS
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3784
Country	:	US
Telephone Number	:	423-339-5656
Fax Number	:	423-339-8889

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	10/25/2010

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