Provider Demographics
NPI:1184828931
Name:SKENANDORE, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SKENANDORE
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 1:434 S GREENBAY RD
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3514
Mailing Address - Country:US
Mailing Address - Phone:262-886-6933
Mailing Address - Fax:
Practice Address - Street 1:6414 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4917
Practice Address - Country:US
Practice Address - Phone:414-463-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator