Provider Demographics
NPI:1407636392
Name:SANDOMENICO, GIANNA MARIE (APN)
Entity Type:Individual
Prefix:
First Name:GIANNA
Middle Name:MARIE
Last Name:SANDOMENICO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 POVERSHON RD
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2005
Mailing Address - Country:US
Mailing Address - Phone:201-687-7524
Mailing Address - Fax:
Practice Address - Street 1:51 JFK PKWY
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2704
Practice Address - Country:US
Practice Address - Phone:917-582-6622
Practice Address - Fax:888-974-2142
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NR18464500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health