Provider Demographics
NPI:1700691987
Name:SANDIFER, KRYSTAL L
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:L
Last Name:SANDIFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5231 E 10 MILE RD APT 205
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-1531
Mailing Address - Country:US
Mailing Address - Phone:313-687-9557
Mailing Address - Fax:
Practice Address - Street 1:5231 E 10 MILE RD APT 205
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-1531
Practice Address - Country:US
Practice Address - Phone:313-687-9557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care