Provider Demographics
NPI:1679522254
Name:SANDELL, TIMOTHY VAUGHN (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:VAUGHN
Last Name:SANDELL
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:7951 SHOAL CREEK BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7582
Mailing Address - Country:US
Mailing Address - Phone:512-584-8404
Mailing Address - Fax:855-592-2816
Practice Address - Street 1:6025 DELMONICO DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2251
Practice Address - Country:US
Practice Address - Phone:719-634-7246
Practice Address - Fax:855-592-2816
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO344082081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01344084Medicaid
COG04712Medicare UPIN
COCB8148Medicare PIN