Provider Demographics
NPI:1942436373
Name:GAVIN, SANDRA (RN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:GAVIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MONPONSETT ST
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:MA
Mailing Address - Zip Code:02338-1404
Mailing Address - Country:US
Mailing Address - Phone:781-294-0106
Mailing Address - Fax:
Practice Address - Street 1:222 MONPONSETT ST
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:MA
Practice Address - Zip Code:02338-1404
Practice Address - Country:US
Practice Address - Phone:781-294-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163397163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0722693Medicare PIN