Provider Demographics
NPI:1295206035
Name:BUCHANAN, SANDRA LAVERNA (LICENSE MASSAGE THER)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LAVERNA
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LICENSE MASSAGE THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 ROUTE 82
Mailing Address - Street 2:
Mailing Address - City:ELIZAVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:846 ROUTE 82
Practice Address - Street 2:
Practice Address - City:ELIZAVILLE
Practice Address - State:NY
Practice Address - Zip Code:12523
Practice Address - Country:US
Practice Address - Phone:518-821-6704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015538225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist