Provider Demographics
NPI:1861176224
Name:SANDOW, LAUREN TAYLOR (PA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:TAYLOR
Last Name:SANDOW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 S LAMAR BLVD APT 316
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-1569
Mailing Address - Country:US
Mailing Address - Phone:281-881-3808
Mailing Address - Fax:
Practice Address - Street 1:164 BELTERRA VILLAGE WAY STE Y700
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-4862
Practice Address - Country:US
Practice Address - Phone:512-610-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16595363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant