Provider Demographics
NPI:1104245927
Name:MCHENRY, SANDRA LOIS (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LOIS
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MOUNTAIN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-6801
Mailing Address - Country:US
Mailing Address - Phone:540-747-2218
Mailing Address - Fax:
Practice Address - Street 1:322 W RIVERSIDE ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1219
Practice Address - Country:US
Practice Address - Phone:540-962-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012553552084N0400X
KY322832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology