MEDICARE: LATONYA SANDERS CMA, RPT, CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	374700000X	Technician	NC
2	251K00000X	Public Health or Welfare Agency	SC
3	246RP1900X	Phlebotomy Technician
4	171W00000X	Contractor	SC
5	172V00000X	Community Health Worker
6	174H00000X	Health Educator	SC
7	246RM2200X	Medical Laboratory Technician
8	376K00000X	Nurse's Aide	VA
9	172V00000X	Community Health Worker	SC

General Provider Information

NPI Number	:	1982170072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATONYA SANDERS CMA, RPT, CNA

Provider Business Mailing Address
First Line	:	4325 DICK POND RD STE B
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6810
Country	:	US
Telephone Number	:	843-353-4651
Fax Number	:	866-446-4652

Provider Business Practice Location Address
First Line	:	4325 DICK POND RD STE B
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6810
Country	:	US
Telephone Number	:	843-353-4651
Fax Number	:	866-446-4652

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

Provider Enumeration Date	:	10/16/2018
Last Update Date	:	01/18/2022

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