Provider Demographics
NPI:1093045635
Name:SARDELLA, NICOLE KATHRYN
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:KATHRYN
Last Name:SARDELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3153
Mailing Address - Country:US
Mailing Address - Phone:530-753-1653
Mailing Address - Fax:
Practice Address - Street 1:24321 COUNTY ROAD 96
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3153
Practice Address - Country:US
Practice Address - Phone:530-753-1653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health