Provider Demographics
NPI:1053924852
Name:SCOTT-ROBERTS, SANDRA RENEE
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:RENEE
Last Name:SCOTT-ROBERTS
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 1:3131 SIMPSON STUART RD APT 2210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-5066
Mailing Address - Country:US
Mailing Address - Phone:214-298-0869
Mailing Address - Fax:
Practice Address - Street 1:8032 MEGAN WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-6625
Practice Address - Country:US
Practice Address - Phone:214-298-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA08610037172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker