Provider Demographics
NPI:1124709357
Name:SANDERS, STEPHEN S
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:SANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20954
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-0954
Mailing Address - Country:US
Mailing Address - Phone:254-722-5311
Mailing Address - Fax:
Practice Address - Street 1:207 OTIS DR STE 7
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-6739
Practice Address - Country:US
Practice Address - Phone:254-722-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty