Provider Demographics
NPI:1366928236
Name:MAGALLAN, SANDY (AUD)
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:
Last Name:MAGALLAN
Suffix:
Gender:F
Credentials:AUD
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 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-8125
Mailing Address - Fax:956-362-8135
Practice Address - Street 1:1100 E DOVE AVE
Practice Address - Street 2:STE 402
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-362-8125
Practice Address - Fax:956-362-8135
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81081237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX395356402Medicaid
TXH08LZ45801OtherBCBS
TX3953564-04Medicaid