Provider Demographics
NPI:1336174192
Name:SANDY, JOHN THOMAS (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:SANDY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:THOMAS
Other - Last Name:SANDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:3330 L AND N DR SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5380
Mailing Address - Country:US
Mailing Address - Phone:256-880-7173
Mailing Address - Fax:256-880-7178
Practice Address - Street 1:3330 L AND N DR SW
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5380
Practice Address - Country:US
Practice Address - Phone:256-880-7173
Practice Address - Fax:256-880-7178
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL974103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL088994OtherVALUE OPTIONS
AL510-43994SANOtherBCBS OF AL
AL4352583OtherAETNA
AL61-69535OtherUBH
ALSA7104OtherREGENCE BCBS
AL510-99490OtherBC-FEP
AL56157OtherCIGNA
ALSA7104OtherREGENCE BCBS