Provider Demographics
NPI:1609950377
Name:DALTON, SANDRA K (DPM,,CPEDORTHIST)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:DALTON
Suffix:
Gender:F
Credentials:DPM,,CPEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 755
Mailing Address - Street 2:501 BAY AVE ST 103
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-926-7006
Mailing Address - Fax:609-926-7016
Practice Address - Street 1:501 BAY AVE STE 103
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2554
Practice Address - Country:US
Practice Address - Phone:609-926-7006
Practice Address - Fax:609-926-7016
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00248000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8133000Medicaid
NJ8133000Medicaid
U70819Medicare UPIN