Provider Demographics
NPI:1003490541
Name:LAWLOR, SANDRA GARAFALO (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:GARAFALO
Last Name:LAWLOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 KNICKERBOCKER RD
Mailing Address - Street 2:
Mailing Address - City:SCHODACK LANDING
Mailing Address - State:NY
Mailing Address - Zip Code:12156-9703
Mailing Address - Country:US
Mailing Address - Phone:518-225-0096
Mailing Address - Fax:
Practice Address - Street 1:847 COUNTY HIGHWAY 122
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-6413
Practice Address - Country:US
Practice Address - Phone:518-346-6121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390637163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY390637OtherNURSE LICENSE