Phyllis L Sanders, MED ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

00030638 Issued in MD

Practice address

6030 Daybreak Cir
Suite a-150, #135
Clarksville, MD 21029-1642

Phone

(443) 535-0266

NPI assigned

Jun 30, 2006

Sex

Female

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)

Not enrolled

Credentials

Master of Education

State licenses

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912936303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6030 DAYBREAK CIR",
            "address_2": "SUITE A-150, #135",
            "city": "CLARKSVILLE",
            "state": "MD",
            "postal_code": "210291642",
            "telephone_number": "443-535-0266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6030 DAYBREAK CIR",
            "address_2": "SUITE A-150, #135",
            "city": "CLARKSVILLE",
            "state": "MD",
            "postal_code": "210291642",
            "telephone_number": "443-535-0266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "PHYLLIS",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "MED ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MD",
            "license": "00030638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Clarksville, MD
• Providers in Clarksville, MD by specialty
• Athletic Trainer in Maryland

• 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.