Provider Demographics
NPI:1689851610
Name:SDANKUS, JAIME L
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:SDANKUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1958
Mailing Address - Country:US
Mailing Address - Phone:617-629-6668
Mailing Address - Fax:
Practice Address - Street 1:167 HOLLAND ST
Practice Address - Street 2:ROOM 133
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2401
Practice Address - Country:US
Practice Address - Phone:617-629-6668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator