Provider Demographics
NPI:1255884326
Name:SARANDON, ALEXIS (MS LAC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:SARANDON
Suffix:
Gender:F
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BENTLEY LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:12514-2543
Mailing Address - Country:US
Mailing Address - Phone:617-833-3231
Mailing Address - Fax:
Practice Address - Street 1:4 BENTLEY LN
Practice Address - Street 2:
Practice Address - City:CLINTON CORNERS
Practice Address - State:NY
Practice Address - Zip Code:12514-2543
Practice Address - Country:US
Practice Address - Phone:617-833-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005621171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist