Provider Demographics
NPI:1982170072
Name:SANDERS, LATONYA (CMA, RPT, CNA)
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:CMA, RPT, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 DICK POND RD STE B
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-6810
Mailing Address - Country:US
Mailing Address - Phone:843-353-4651
Mailing Address - Fax:866-446-4652
Practice Address - Street 1:4325 DICK POND RD STE B
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6810
Practice Address - Country:US
Practice Address - Phone:843-353-4651
Practice Address - Fax:866-446-4652
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374700000X
SC251K00000X, 171W00000X, 174H00000X, 172V00000X
246RP1900X, 172V00000X, 246RM2200X
VA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No374700000XNursing Service Related ProvidersTechnician
No251K00000XAgenciesPublic Health or Welfare
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No171W00000XOther Service ProvidersContractor
No174H00000XOther Service ProvidersHealth Educator
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No376K00000XNursing Service Related ProvidersNurse's Aide