Provider Demographics
NPI:1679374045
Name:SAND, ADYSON MAE
Entity type:Individual
Prefix:
First Name:ADYSON
Middle Name:MAE
Last Name:SAND
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7905 S GRASS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-6229
Mailing Address - Country:US
Mailing Address - Phone:605-906-0725
Mailing Address - Fax:
Practice Address - Street 1:5801 HIDCOTE DR STE 300
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5569
Practice Address - Country:US
Practice Address - Phone:402-665-4687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant