Provider Demographics
NPI:1528232113
Name:SANDERSON, JOYCE DANDREO (PA-C)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:DANDREO
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WASHINGTON ST
Mailing Address - Street 2:FLOATING HOSPITAL, RM 401
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1526
Mailing Address - Country:US
Mailing Address - Phone:617-636-7920
Mailing Address - Fax:617-636-9107
Practice Address - Street 1:750 WASHINGTON ST
Practice Address - Street 2:FLOATING HOSPITAL, RM 401
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-7920
Practice Address - Fax:617-636-9107
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2484363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical