Provider Demographics
NPI:1689657082
Name:SANDVIG, JENIFER L (MD)
Entity Type:Individual
Prefix:DR
First Name:JENIFER
Middle Name:L
Last Name:SANDVIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 E 3900 S
Mailing Address - Street 2:#360
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1228
Mailing Address - Country:US
Mailing Address - Phone:801-264-8686
Mailing Address - Fax:801-264-8962
Practice Address - Street 1:1140 E 3900 S
Practice Address - Street 2:#360
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1228
Practice Address - Country:US
Practice Address - Phone:801-264-8686
Practice Address - Fax:801-264-8962
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT285715-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics