Basic Information
| Provider Information | |||||||||
| NPI: | 1306510128 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDARY | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | JEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6930 FAIR OAKS BLVD APT 148 | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956083373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4084102596 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3628 MADISON AVE. SUITE #6 | ||||||||
| Address2: | |||||||||
| City: | NORTH HIGHLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163883231 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2021 | ||||||||
| LastUpdateDate: | 09/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.