Provider Demographics
NPI:1700345048
Name:DESGRAVES, SANDRA (RRT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:DESGRAVES
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22129 SW 103RD AVE
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1137
Mailing Address - Country:US
Mailing Address - Phone:786-597-2147
Mailing Address - Fax:
Practice Address - Street 1:22129 SW 103RD AVE
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1137
Practice Address - Country:US
Practice Address - Phone:786-597-2147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2019-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Single Specialty