Provider Demographics
NPI:1033487590
Name:SARDINA, JACQUELYN ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:ANN
Last Name:SARDINA
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 1:4150 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1042
Mailing Address - Country:US
Mailing Address - Phone:716-250-1460
Mailing Address - Fax:716-250-1475
Practice Address - Street 1:4150 MAPLE RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1042
Practice Address - Country:US
Practice Address - Phone:716-250-1460
Practice Address - Fax:716-250-1475
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22486892163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool