Provider Demographics
NPI:1336727312
Name:SANDIFER, FRANCES A (LMT)
Entity Type:Individual
Prefix:MRS
First Name:FRANCES
Middle Name:A
Last Name:SANDIFER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:FRANCES
Other - Middle Name:A
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:189 MAIN ROAD STE. A
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-1957
Mailing Address - Country:US
Mailing Address - Phone:631-369-4323
Mailing Address - Fax:631-369-4325
Practice Address - Street 1:189 MAIN ROAD STE. A
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-1957
Practice Address - Country:US
Practice Address - Phone:631-369-4323
Practice Address - Fax:631-369-4325
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019221-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist