Provider Demographics
NPI:1750751988
Name:BLESSED SOLES PODIATRY. LLC
Entity type:Organization
Organization Name:BLESSED SOLES PODIATRY. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANTEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:302-765-8566
Mailing Address - Street 1:804 LONGMAID DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-6241
Mailing Address - Country:US
Mailing Address - Phone:302-765-8566
Mailing Address - Fax:410-871-8721
Practice Address - Street 1:606 HAMMONDS LN
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MD
Practice Address - Zip Code:21225-3301
Practice Address - Country:US
Practice Address - Phone:443-213-5900
Practice Address - Fax:410-871-8721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty