Provider Demographics
NPI:1922259274
Name:SPOTH, SANDRA L (RN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:SPOTH
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9270 LAPP RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9305
Mailing Address - Country:US
Mailing Address - Phone:716-741-4239
Mailing Address - Fax:
Practice Address - Street 1:9270 LAPP RD
Practice Address - Street 2:
Practice Address - City:CLARENCE CENTER
Practice Address - State:NY
Practice Address - Zip Code:14032-9305
Practice Address - Country:US
Practice Address - Phone:716-741-4239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY358693-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse