Provider Demographics
NPI:1316205479
Name:RYDER, SANDRA JO (CPNP- PC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JO
Last Name:RYDER
Suffix:
Gender:F
Credentials:CPNP- PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-5770
Mailing Address - Country:US
Mailing Address - Phone:484-942-9754
Mailing Address - Fax:
Practice Address - Street 1:717 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5770
Practice Address - Country:US
Practice Address - Phone:484-942-9754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011689363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics