MEDICARE: SANDRIA LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1972455038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDRIA LLC

Provider Business Mailing Address
First Line	:	10439 STROMA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-6729
Country	:	US
Telephone Number	:	702-806-3837
Fax Number	:	702-806-3837

Provider Business Practice Location Address
First Line	:	10439 STROMA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-6729
Country	:	US
Telephone Number	:	702-806-3837
Fax Number	:	702-806-3837

Authorized Official
Title or Position	:	CEO
Name	:	LATOYA WILSON
Credential	:	WILSON
Telephone Number	:	702-806-3837

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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