Organization
SANDBULTE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHELLEY L SANDBULTE ED.D., LP (OWNER-PSYCHOLOGIST)
(605) 332-1700
Entity
Organization
Contact information
Practice address
2210 W. BROWN PLACE, SIOUX FALLS, SD 57105
(605) 332-1700
(605) 336-9031
Mailing address
2210 W BROWN PLACE, SIOUX FALLS, SD 57105
(605) 332-1700
(605) 336-9031
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
311
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004659
BLUE CROSS BLUE SHIELD
SD
05
—
6550683
—
SD
Enumeration date
04/02/2007
Last updated
08/22/2020
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