Provider Demographics
NPI:1891709705
Name:CONDRY, SANDRA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:M
Last Name:CONDRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:FREEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13068-5714
Mailing Address - Country:US
Mailing Address - Phone:607-898-5047
Mailing Address - Fax:607-898-5047
Practice Address - Street 1:738 SHELDON RD
Practice Address - Street 2:
Practice Address - City:FREEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13068-5714
Practice Address - Country:US
Practice Address - Phone:607-898-5047
Practice Address - Fax:607-898-5047
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009309-1103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent