Provider Demographics
NPI:1467882969
Name:JOLLEY, SANDRA (RD)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:JOLLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SOUTH AVENUE
Mailing Address - Street 2:DEPARTMENT OF SURGERY-
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620
Mailing Address - Country:US
Mailing Address - Phone:585-341-8408
Mailing Address - Fax:
Practice Address - Street 1:1000 SOUTH AVENUE
Practice Address - Street 2:DEPARTMENT OF SURGERY-
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620
Practice Address - Country:US
Practice Address - Phone:585-341-8408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL807184133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered