Basic Information
| Provider Information | |||||||||
| NPI: | 1972569069 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHULTZ | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 SUMMIT CROSSING PL STE 203 | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046717390 | ||||||||
| FaxNumber: | 7046717146 | ||||||||
| Practice Location | |||||||||
| Address1: | 640 SUMMIT CROSSING PL STE 203 | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046717390 | ||||||||
| FaxNumber: | 7046717146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 11/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 9501657 | NC | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.