Provider Demographics
NPI:1396827861
Name:LEVY, SANDRA P (PNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:P
Last Name:LEVY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 PROFESSIONAL CENTER DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4334
Mailing Address - Country:US
Mailing Address - Phone:415-448-1555
Mailing Address - Fax:415-892-8732
Practice Address - Street 1:400 PROFESSIONAL CENTER DR
Practice Address - Street 2:SUITE 424
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4367
Practice Address - Country:US
Practice Address - Phone:415-448-1555
Practice Address - Fax:415-892-8732
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP11022363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics