Provider Demographics
NPI:1568602613
Name:QUINTAL, SANDRA ALEXANDRINA (PSYCH NP, PSYCH CNS)
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:ALEXANDRINA
Last Name:QUINTAL
Suffix:
Gender:F
Credentials:PSYCH NP, PSYCH CNS
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Other - First Name:
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Mailing Address - Street 1:26 CITY HALL MALL
Mailing Address - Street 2:3RD FLOOR BEHAVIORAL HEALTH
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4754
Mailing Address - Country:US
Mailing Address - Phone:781-306-5100
Mailing Address - Fax:
Practice Address - Street 1:26 CITY HALL MALL
Practice Address - Street 2:3RD FLOOR BEHAVIORAL HEALTH
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4754
Practice Address - Country:US
Practice Address - Phone:781-306-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN205657363LP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult