Provider Demographics
NPI:1265697320
Name:SIAN, SANDY L
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:L
Last Name:SIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:L
Other - Last Name:SHELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:561-478-8770
Mailing Address - Fax:561-688-8877
Practice Address - Street 1:4301 CANAL AVE SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2667
Practice Address - Country:US
Practice Address - Phone:616-257-7880
Practice Address - Fax:616-257-0580
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI237600000X
MI3501004909237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M38010Medicare PIN