| Doctor Name: | BRANDY ELUA SANDE |
| NPI Number: | 1609150168 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | |
| Business Practice Address: | 2900 Doolittle Dr Ellsworth Afb, SD - 577064821 |
| Business Phone Number: | 6053853208 |
| Business Fax Number: | 6053853115 |
| Mailing Address: | 1203 Saint Andrew St, RAPID CITY |
| State: | SD |
| Postal Code: | 577014472 |
| Phone Number: | 2402104823 |
| Fax Number: | |
| NPI Enumeration Date: | 10/03/2011 |
| NPI Last Update Date: | 10/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |