Provider Demographics
NPI:1568664944
Name:SANDROW, CHERISA (DO)
Entity type:Individual
Prefix:
First Name:CHERISA
Middle Name:
Last Name:SANDROW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHERISA
Other - Middle Name:
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:60766 GOLF VILLAGE LOOP
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9132
Mailing Address - Country:US
Mailing Address - Phone:503-407-9112
Mailing Address - Fax:
Practice Address - Street 1:60766 GOLF VILLAGE LOOP
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-9132
Practice Address - Country:US
Practice Address - Phone:503-407-9112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60001820207Q00000X
ORDO174412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8516643Medicaid
OR500610843Medicaid
WAG8885985Medicare PIN