Provider Demographics
NPI:1902352024
Name:SCIANDRA, KATHRYN
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SCIANDRA
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 1:418 COLVIN AVE
Mailing Address - Street 2:UPPER
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-1824
Mailing Address - Country:US
Mailing Address - Phone:315-378-7071
Mailing Address - Fax:
Practice Address - Street 1:418 COLVIN AVE
Practice Address - Street 2:UPPER
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-1824
Practice Address - Country:US
Practice Address - Phone:315-378-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720483164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse