Provider Demographics
NPI:1023080447
Name:SANDY, JENNIFER DOUBLESTEIN (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DOUBLESTEIN
Last Name:SANDY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 SHELDON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2479
Mailing Address - Country:US
Mailing Address - Phone:616-847-5489
Mailing Address - Fax:616-847-5479
Practice Address - Street 1:1445 SHELDON RD STE 201
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2479
Practice Address - Country:US
Practice Address - Phone:616-847-5489
Practice Address - Fax:616-847-5479
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201734207R00000X
MI5101015469207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080G011310OtherBCBSM GRP PIN
MI1157010844OtherBCBSM IND PIN
MI080G011310OtherBCBSM GRP PIN
MI1157010844OtherBCBSM IND PIN