Provider Demographics
NPI:1083782627
Name:BURMYLO-MAGRANN, SANDRA MARY (NP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MARY
Last Name:BURMYLO-MAGRANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:MARY
Other - Last Name:BURMYLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:151 PATTY BOWKER RD
Mailing Address - Street 2:
Mailing Address - City:TABERNACLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08088
Mailing Address - Country:US
Mailing Address - Phone:609-268-7070
Mailing Address - Fax:609-748-6721
Practice Address - Street 1:53 W WHITE HORSE PIKE STE D
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9450
Practice Address - Country:US
Practice Address - Phone:609-748-2800
Practice Address - Fax:609-748-6721
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09422800363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner