Provider Demographics
NPI:1114518644
Name:SANDY, ABIE (NP)
Entity Type:Individual
Prefix:
First Name:ABIE
Middle Name:
Last Name:SANDY
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 1:1260 BONINO WAY
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020
Mailing Address - Country:US
Mailing Address - Phone:408-569-8752
Mailing Address - Fax:
Practice Address - Street 1:4400 CAPITOLA RD STE 200
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3571
Practice Address - Country:US
Practice Address - Phone:831-426-9302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily