Provider Demographics
NPI:1184829731
Name:SANDERS, JILL (DO)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TECHNOLOGY DR
Mailing Address - Street 2:UNIT #8
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-9181
Mailing Address - Country:US
Mailing Address - Phone:802-257-8989
Mailing Address - Fax:
Practice Address - Street 1:20 TECHNOLOGY DR
Practice Address - Street 2:UNIT #8
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-9181
Practice Address - Country:US
Practice Address - Phone:802-257-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTF47297Medicare UPIN
VTSAVN2960Medicare PIN