Provider Demographics
NPI:1679911143
Name:ROSS, SANDRA V (NP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:V
Last Name:ROSS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1335
Mailing Address - Country:US
Mailing Address - Phone:607-324-0660
Mailing Address - Fax:
Practice Address - Street 1:5047 GERRARDSTOWN RD STE 2A
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:WV
Practice Address - Zip Code:25428-3951
Practice Address - Country:US
Practice Address - Phone:304-229-2273
Practice Address - Fax:304-821-1450
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV95324363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics