Provider Demographics
NPI:1366565723
Name:CARUSA, SANDRA SHAPP (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:SHAPP
Last Name:CARUSA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5414 NORTHERN LIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-4433
Mailing Address - Country:US
Mailing Address - Phone:314-606-5360
Mailing Address - Fax:314-529-3530
Practice Address - Street 1:400 CHESTERFIELD CTR STE 400
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4800
Practice Address - Country:US
Practice Address - Phone:314-606-5360
Practice Address - Fax:314-529-3530
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01934103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist