Provider Demographics
NPI:1568271104
Name:DAVIS, SANDARETTA
Entity type:Individual
Prefix:
First Name:SANDARETTA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 NIBLIC DR
Mailing Address - Street 2:
Mailing Address - City:OVERLAND
Mailing Address - State:MO
Mailing Address - Zip Code:63114-2245
Mailing Address - Country:US
Mailing Address - Phone:314-322-6026
Mailing Address - Fax:
Practice Address - Street 1:10300 NIBLIC DR
Practice Address - Street 2:
Practice Address - City:OVERLAND
Practice Address - State:MO
Practice Address - Zip Code:63114-2245
Practice Address - Country:US
Practice Address - Phone:314-322-6026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula