Sandra Waller, CERTIFIED HAIR LOSS

Primary specialty

Prosthetics Case ManagementTaxonomy code 1744P3200X

License

1201080783 Issued in VA

Practice address

3106 Memorial Ave
Lynchburg, VA 24501-3730

Phone

(434) 845-4448

NPI assigned

Sep 8, 2014

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1410134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410134400000",
    "number": "1609277888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3106 MEMORIAL AVE",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245013730",
            "telephone_number": "434-845-4448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3106 MEMORIAL AVE",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245013730",
            "telephone_number": "434-845-4448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "SANDRA",
        "credential": "CERTIFIED HAIR LOSS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-08",
        "last_updated": "2014-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1744P3200X",
            "taxonomy_group": "",
            "desc": "Specialist, Prosthetics Case Management",
            "state": "VA",
            "license": "1201080783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deaven McGuire Wallace, MA, LPC
• Donald McQuire Wallace, DDS
• Kojo Wallace, MD
• William Miles Wallace
• Brenda Sue Waller, M.D.
• John Wallman, PT
• Mary Wallman, PT
• Matthew Robert Wallman, PA-C
• Evan Rhys Walsh
• Hillary Walsh

• Prosthetics Case Management in Lynchburg, VA
• Providers in Lynchburg, VA by specialty
• Prosthetics Case Management in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2014; 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.