Provider Demographics
NPI:1790258515
Name:DONDA, SANDRA MARIE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:DONDA
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 1:10 JESSICA PL
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-1611
Mailing Address - Country:US
Mailing Address - Phone:407-697-7895
Mailing Address - Fax:315-765-6975
Practice Address - Street 1:10 JESSICA PL
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492-1611
Practice Address - Country:US
Practice Address - Phone:407-697-7895
Practice Address - Fax:315-765-6975
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220856-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse