Provider Demographics
NPI:1861917874
Name:DAVIS, SANDRA COLLEEN (LPN)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:COLLEEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STONINGTON LN APT 2
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1564
Mailing Address - Country:US
Mailing Address - Phone:716-479-1820
Mailing Address - Fax:
Practice Address - Street 1:9060 GREINER RD
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1105
Practice Address - Country:US
Practice Address - Phone:716-390-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257061164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse