Melanie Fleur Sandoval, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APN.0995300-NP Issued in CO

Practice address

1020 Lakeview Ave
Pueblo, CO 81004-3508

Phone

(719) 557-3660

Fax

(719) 557-3690

NPI assigned

Nov 19, 2019

Last updated

Dec 15, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Novamentis PC

  • Acute Care Nurse Practitioner
  • Colorado Springs, CO
  • NPI 1821622176

  Multi-Specialty

  NPD Authorized official
• Gleneagle Vision Center, P.C.

  • Optometrist
  • Colorado Springs, CO
  • NPI 1851507420

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1407492929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 800022",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641800022",
            "telephone_number": "800-953-0104",
            "fax_number": "303-765-6670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 LAKEVIEW AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043508",
            "telephone_number": "719-557-3660",
            "fax_number": "719-557-3690"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2212 Red Edge Hts",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809217227",
            "country_code": "US",
            "telephone_number": "720-900-6250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDOVAL",
        "first_name": "MELANIE",
        "middle_name": "FLEUR",
        "name_prefix": "Dr.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-19",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "APN.0995300-NP",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CO",
            "license": "0178632",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CO",
            "license": "0178632",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CO",
            "license": "0178632",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000181288",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charmayne N Sandoval, LCSW
• Jason Sandoval
• Joella Sandoval
• John R. Sandoval, MD
• Leticia Sandoval
• Melissa L Sandoval
• Mindy Lea Sandoval
• Veronica Sandoval, ANP
• Sarah Nicole Sandstrom, MA, CAC-II
• Tyleen Irene Sandstrom, BSW

• Nurse Practitioner in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; 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.