Provider Demographics
NPI:1609174887
Name:SANDLIN, PAMELA R (LPN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:SANDLIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 RAINES PARK
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14613-1447
Mailing Address - Country:US
Mailing Address - Phone:585-775-6135
Mailing Address - Fax:
Practice Address - Street 1:70 RAINES PARK
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14613-1447
Practice Address - Country:US
Practice Address - Phone:585-775-6135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229905164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse