Provider Demographics
NPI:1023997236
Name:SANDERS, BEVERLY CAROL
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:CAROL
Last Name:SANDERS
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 1:12545 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-1819
Mailing Address - Country:US
Mailing Address - Phone:313-600-3495
Mailing Address - Fax:
Practice Address - Street 1:12545 WILSHIRE DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-1819
Practice Address - Country:US
Practice Address - Phone:313-600-3495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker