Provider Demographics
NPI:1902415383
Name:SANDERLIN, LANARD DONTE
Entity Type:Individual
Prefix:MR
First Name:LANARD
Middle Name:DONTE
Last Name:SANDERLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5242 SYLVESTER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-1816
Mailing Address - Country:US
Mailing Address - Phone:267-582-6571
Mailing Address - Fax:
Practice Address - Street 1:5242 SYLVESTER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-1816
Practice Address - Country:US
Practice Address - Phone:267-582-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA29434224172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver