Provider Demographics
NPI:1770792749
Name:DISANDRO, DIANE (IBCLC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:DISANDRO
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1739
Mailing Address - Country:US
Mailing Address - Phone:610-539-4476
Mailing Address - Fax:610-539-6308
Practice Address - Street 1:688 SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19403-1739
Practice Address - Country:US
Practice Address - Phone:610-539-4476
Practice Address - Fax:610-539-6308
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist