Michael Quintin Sanderson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

12125A Issued in WY

Practice address

916 Jackson Ave
Sheridan, WY 82801-2708

Phone

(307) 675-5555

Fax

(307) 675-5599

NPI assigned

Jun 1, 2016

Last updated

Jun 30, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northeast Wyoming Pediatric Associates, P.C.

  • Pediatrics Physician
  • Sheridan, WY
  • NPI 1114998259
  NPD
• Memorial Hospital of Sheridan County

  dba Sheridan Memorial Hospital

  • General Acute Care Hospital
  • Sheridan, WY
  • NPI 1487707188
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561852800000",
    "number": "1053769943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "916 JACKSON AVE",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828012708",
            "telephone_number": "307-675-5555",
            "fax_number": "307-675-5599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 JACKSON AVE",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828012708",
            "telephone_number": "307-675-5555",
            "fax_number": "307-675-5599"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1919 E Thomas Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850167710",
            "country_code": "US",
            "telephone_number": "602-345-5885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDERSON",
        "first_name": "MICHAEL",
        "middle_name": "QUINTIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-01",
        "last_updated": "2019-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WY",
            "license": "12125A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Richelle Salyards
• Clinton Salyards
• Kara Jean Sampey, RN, BSN
• Kymberlie Mae Samson
• Jesse Sanders
• Melony Ray Sanford, M. ED. LPCC
• Sara Medeical Supplies
• Kelly Elizabeth Saur, PCSW
• Marisa Scalise, RN
• Catherine Scalley, PHARMD

• Pediatrics Physician in Sheridan, WY
• Providers in Sheridan, WY by specialty
• Pediatrics Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.