Provider Demographics
NPI:1447376421
Name:SHEHADEH, SANDRA FANG (PT)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:FANG
Last Name:SHEHADEH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:SHEHADEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:9909 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6361
Mailing Address - Country:US
Mailing Address - Phone:240-864-6200
Mailing Address - Fax:240-864-6209
Practice Address - Street 1:9909 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6361
Practice Address - Country:US
Practice Address - Phone:240-864-6200
Practice Address - Fax:240-864-6209
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist