Provider Demographics
NPI:1447382270
Name:FEDERO, SANDRA J (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:J
Last Name:FEDERO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:PA
Mailing Address - Zip Code:18651-4405
Mailing Address - Country:US
Mailing Address - Phone:570-779-4892
Mailing Address - Fax:
Practice Address - Street 1:1181 FREEDOM RD
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-4913
Practice Address - Country:US
Practice Address - Phone:724-742-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP004337B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily