Provider Demographics
NPI:1033793039
Name:SANDHU, MOFFETT PRIDDY (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MOFFETT
Middle Name:PRIDDY
Last Name:SANDHU
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 OAK POINT LANDING DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6279
Mailing Address - Country:US
Mailing Address - Phone:804-513-2168
Mailing Address - Fax:
Practice Address - Street 1:172 OAK POINT LANDING DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6279
Practice Address - Country:US
Practice Address - Phone:804-513-2168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist