Provider Demographics
NPI:1053018655
Name:SANDERS, MARGIE MAE
Entity type:Individual
Prefix:
First Name:MARGIE
Middle Name:MAE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 WHITE BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12842-1422
Mailing Address - Country:US
Mailing Address - Phone:518-648-6497
Mailing Address - Fax:518-648-6143
Practice Address - Street 1:139 WHITE BIRCH LN
Practice Address - Street 2:
Practice Address - City:INDIAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12842-1422
Practice Address - Country:US
Practice Address - Phone:518-648-6497
Practice Address - Fax:518-648-6143
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator