Provider Demographics
NPI:1033206792
Name:FORD, SANDRA (NP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6400
Mailing Address - Country:US
Mailing Address - Phone:315-342-3166
Mailing Address - Fax:315-343-6531
Practice Address - Street 1:299 E RIVER RD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6400
Practice Address - Country:US
Practice Address - Phone:315-342-3166
Practice Address - Fax:315-343-6531
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0330F330672363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0330F330672OtherNYS LICENSE NUMBER