S4 Sand PLLC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA04819 Issued in TX

Legal business name

S4 SAND PLLC

Practice address

3909 Yarberry CT
Roanoke, TX 76262-3355

Phone

(817) 733-2002

NPI assigned

Feb 26, 2017

Organization subpart

No

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

Authorized official

Name

Stefanie Sanderson, PA-CNPI 1750385456

Title

Owner/Physician Assistant

Phone

(817) 733-2002

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stefanie N Sanderson, PA-C

  • Surgical Physician Assistant
  • Southlake, TX
  • NPI 1750385456
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1488067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488067200000",
    "number": "1679013536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 502",
            "city": "ROANOKE",
            "state": "TX",
            "postal_code": "762620502",
            "telephone_number": "817-733-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3909 YARBERRY CT",
            "city": "ROANOKE",
            "state": "TX",
            "postal_code": "762623355",
            "telephone_number": "817-733-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S4 SAND PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-26",
        "last_updated": "2017-02-26",
        "status": "A",
        "authorized_official_last_name": "SANDERSON",
        "authorized_official_first_name": "STEFANIE",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "817-733-2002",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA04819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Robison, DMD
• Diana Alejandra Rojas, ELECTROLOGIST/ AEST
• Olena Romenska, M.D.
• Yu Rong
• Cindy Russell, SPEECH PATHOLOGIST
• Daniel Aerol Pado Sadural, PT, DPT
• Denise Sanchez
• Auttaria Shinault
• Clara Silbernagel, A.T.C., L.A.T.
• Silver Lifts Transportation Company LLC

• Surgical Physician Assistant in Roanoke, TX
• Providers in Roanoke, TX by specialty
• Surgical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.