Individual provider Active NPI

Sandra Yasskin, L.O.T.

  • Specialist
  • Bryan, TX
National Provider Identifier
1093727828
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
100920 Issued in TX
Practice address
302 E 24TH St
Bryan, TX 77803-5303
Phone
(979) 821-9474
NPI assigned
Aug 12, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 100920 TX Primary

Addresses

Primary practice location

302 E 24TH St
Bryan, TX 77803-5303

Mailing address

2901 Jennifer Dr
College Station, TX 77845-5755
Phone (979) 696-6661

Other identifiers 1

IdentifierTypeStateIssuer
83012TMedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
100920TXMDSpecialist

NPI Registry JSON

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093727828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 JENNIFER DR",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778455755",
            "telephone_number": "979-696-6661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 E 24TH ST",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778035303",
            "telephone_number": "979-821-9474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YASSKIN",
        "first_name": "SANDRA",
        "name_prefix": "Ms.",
        "credential": "L.O.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "100920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "83012T",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryan, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.