Provider Demographics
NPI:1487533436
Name:MOORE, SANDRA GWINNETTA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:GWINNETTA
Last Name:MOORE
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 1:4296 E 163RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2457
Mailing Address - Country:US
Mailing Address - Phone:216-744-5550
Mailing Address - Fax:
Practice Address - Street 1:4296 E 163RD ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2457
Practice Address - Country:US
Practice Address - Phone:216-744-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide