Provider Demographics
NPI:1104163856
Name:SANDERS, DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5763 FOX CHASE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-3085
Mailing Address - Country:US
Mailing Address - Phone:478-278-7066
Mailing Address - Fax:
Practice Address - Street 1:1570 NC 8 AND 89 HWY N
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:NC
Practice Address - Zip Code:27016-7360
Practice Address - Country:US
Practice Address - Phone:336-593-2831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04018207P00000X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant