| Sandra L Shuya Pc | |
|
1245 Country Club Rd Ste. 200 Santa Teresa NM 88008-9743 | |
| (915) 235-7676 | |
| (915) 243-6006 |
| Full Name | Sandra L Shuya Pc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1245 Country Club Rd, Santa Teresa, New Mexico |
| Authorized Official Name and Position | Sandra Shuya (PRESIDENT) |
| Authorized Official Contact | 9152357676 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sandra L Shuya Pc 1245 Country Club Rd Ste. 200 Santa Teresa NM 88008-9743 Ph: (915) 235-7676 | Sandra L Shuya Pc 1245 Country Club Rd Ste. 200 Santa Teresa NM 88008-9743 Ph: (915) 235-7676 |
| NPI Number | 1316339948 |
|---|---|
| Provider Enumeration Date | 02/18/2015 |
| Last Update Date | 02/18/2015 |
| Medicare PECOS PAC ID | 6305114463 |
|---|---|
| Medicare Enrollment ID | O20170613001923 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316339948 | NPI | - | NPPES |
| 1932478955 | Other | TX | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | CNP-02567 (New Mexico) | Primary |
| Provider Name | Sandra L Shuya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932478955 PECOS PAC ID: 4486955838 Enrollment ID: I20151209001334 |
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