Provider Demographics
NPI:1942603113
Name:SANDERS, TYLER SHANELLE
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:SHANELLE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9360 STATION ST STE 400
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6811
Mailing Address - Country:US
Mailing Address - Phone:512-766-8749
Mailing Address - Fax:
Practice Address - Street 1:9360 STATION ST STE 400
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6811
Practice Address - Country:US
Practice Address - Phone:512-766-8749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1942603113Medicaid