Individual
AYISHA SANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC, APRN-CNP
Contact information
Practice address
3330 MATLOCK RD STE 202B, ARLINGTON, TX 76015-2921
(503) 662-9385
(503) 782-8301
Mailing address
547 BRETON DR, GRAND PRAIRIE, TX 75052-2525
(503) 662-9385
(503) 782-8301
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
897183
TX
163WP0808X
Psychiatric/Mental Health Registered Nurse
202114666RN
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1057466
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
202114948
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15458727
CAQH ID
—
05
—
500802692
—
OR
Enumeration date
09/27/2021
Last updated
07/30/2024
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