Provider Demographics
NPI:1538598339
Name:DOYLE, SANDRA J (IBCLC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:DOYLE
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:4 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2705
Mailing Address - Country:US
Mailing Address - Phone:856-912-1887
Mailing Address - Fax:
Practice Address - Street 1:4 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2705
Practice Address - Country:US
Practice Address - Phone:856-912-1887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11187257174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN