Provider Demographics
NPI:1508548199
Name:GANDAREZ, SANDRA ALVES (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ALVES
Last Name:GANDAREZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1310
Mailing Address - Country:US
Mailing Address - Phone:201-982-0590
Mailing Address - Fax:
Practice Address - Street 1:8901 KENNEDY BLVD STE 1W
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5344
Practice Address - Country:US
Practice Address - Phone:201-430-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14890600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health