Provider Demographics
NPI:1417781071
Name:HABY, SANDY (CHWI, CHW)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:HABY
Suffix:
Gender:
Credentials:CHWI, CHW
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHWI, CHW
Mailing Address - Street 1:66 CINNAMON LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-5453
Mailing Address - Country:US
Mailing Address - Phone:325-245-5770
Mailing Address - Fax:
Practice Address - Street 1:10425 CARDINAL RD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-6918
Practice Address - Country:US
Practice Address - Phone:325-245-5770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker