Organization
S4 SAND PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEFANIE SANDERSON PA-C (OWNER/PHYSICIAN ASSISTANT)
(817) 733-2002
Entity
Organization
Contact information
Practice address
3909 YARBERRY CT, ROANOKE, TX 76262-3355
(817) 733-2002
Mailing address
PO BOX 502, ROANOKE, TX 76262-0502
(817) 733-2002
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA04819
TX
Other
Enumeration date
02/26/2017
Last updated
02/26/2017
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