MEDICARE: SANDRA K DALTON DPM,,C.PEDORTHIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	25MD00248000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609950377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA K DALTON DPM,,C.PEDORTHIST

Provider Business Mailing Address
First Line	:	PO BOX 755
Second Line	:	501 BAY AVE ST 103
City	:	SOMERS POINT
State	:	NJ
Zip	:	08244
Country	:	US
Telephone Number	:	609-926-7006
Fax Number	:	609-926-7016

Provider Business Practice Location Address
First Line	:	501 BAY AVE STE 103
Second Line	:
City	:	SOMERS POINT
State	:	NJ
Zip	:	08244-2554
Country	:	US
Telephone Number	:	609-926-7006
Fax Number	:	609-926-7016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	06/22/2010

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