Provider Demographics
NPI:1235949454
Name:DEREYNA, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:DEREYNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 LINDA CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3664
Mailing Address - Country:US
Mailing Address - Phone:214-554-4356
Mailing Address - Fax:
Practice Address - Street 1:809 LINDA CT
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3664
Practice Address - Country:US
Practice Address - Phone:214-554-4356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA0061061378376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide