Provider Demographics
NPI:1255549770
Name:SAMBANDHAM, MARY E (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:SAMBANDHAM
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 1:5984 W SOUTH RANGE RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-9248
Mailing Address - Country:US
Mailing Address - Phone:330-533-5173
Mailing Address - Fax:
Practice Address - Street 1:420 YOUNGSTOWN POLAND RD
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1058
Practice Address - Country:US
Practice Address - Phone:330-755-2147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN171288163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse