Provider Demographics
NPI:1114216835
Name:EVANS, SANDRA L (MPH)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117-B WEST PALMETTO STREET
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-3925
Mailing Address - Country:US
Mailing Address - Phone:843-758-4587
Mailing Address - Fax:
Practice Address - Street 1:712 BULTMAN DR
Practice Address - Street 2:SUITE D-1
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2553
Practice Address - Country:US
Practice Address - Phone:843-758-4587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor