Provider Demographics
NPI:1861628620
Name:SANDOVAL, ANDREA RENAE (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:RENAE
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2509 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2233
Mailing Address - Country:US
Mailing Address - Phone:785-623-5095
Mailing Address - Fax:785-623-5080
Practice Address - Street 1:2509 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2233
Practice Address - Country:US
Practice Address - Phone:785-623-5095
Practice Address - Fax:785-623-5080
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007017367207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine