Provider Demographics
NPI:1386064202
Name:MELCHOR, SANDRA POWELL (CCP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:POWELL
Last Name:MELCHOR
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:DIANE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCP
Mailing Address - Street 1:8518 SHOOTING QUAIL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-4613
Mailing Address - Country:US
Mailing Address - Phone:850-459-5482
Mailing Address - Fax:
Practice Address - Street 1:8518 SHOOTING QUAIL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-4613
Practice Address - Country:US
Practice Address - Phone:850-459-5482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF1208242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist