Provider Demographics
NPI:1417133505
Name:VANDYKE, SANDRA B (RN)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:B
Last Name:VANDYKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ASPEN CT
Mailing Address - Street 2:
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-1506
Mailing Address - Country:US
Mailing Address - Phone:845-593-2171
Mailing Address - Fax:845-593-2171
Practice Address - Street 1:12 ASPEN CT
Practice Address - Street 2:
Practice Address - City:PAWLING
Practice Address - State:NY
Practice Address - Zip Code:12564-1506
Practice Address - Country:US
Practice Address - Phone:845-593-2171
Practice Address - Fax:845-593-2171
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209131163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse