Provider Demographics
NPI:1427327089
Name:WITHERSPOON, SANDRA KAY
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:KAY
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:KAY
Other - Last Name:SNEED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 SUFFOLK AVE
Mailing Address - Street 2:#319
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-3000
Mailing Address - Country:US
Mailing Address - Phone:832-488-4642
Mailing Address - Fax:240-788-6544
Practice Address - Street 1:505 SUFFOLK AVE
Practice Address - Street 2:#319
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-3000
Practice Address - Country:US
Practice Address - Phone:832-488-4642
Practice Address - Fax:240-788-6544
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion