Provider Demographics
NPI:1811730922
Name:KIRK, SANDY MICHELLE
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:MICHELLE
Last Name:KIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:MICHELLE
Other - Last Name:GOMEZ-HENRIQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:475 EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-8710
Mailing Address - Country:US
Mailing Address - Phone:540-830-7458
Mailing Address - Fax:
Practice Address - Street 1:17068 CHARLES M LANKFORD JR MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:EASTVILLE
Practice Address - State:VA
Practice Address - Zip Code:23347
Practice Address - Country:US
Practice Address - Phone:757-331-1086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program