Provider Demographics
NPI:1356557102
Name:SAYRE, SANDRA ELAINE (FNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELAINE
Last Name:SAYRE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5164 JONATHAN LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-6008
Mailing Address - Country:US
Mailing Address - Phone:540-904-2964
Mailing Address - Fax:
Practice Address - Street 1:402 4TH ST SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24013-1404
Practice Address - Country:US
Practice Address - Phone:540-777-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily