MEDICARE: SANDRA G GAROFALO NP

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	363LG0600X	Gerontology Nurse Practitioner	71009312A	IN
2	363L00000X	Nurse Practitioner	28250260A	IN

General Provider Information

NPI Number	:	1689221905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA G GAROFALO NP

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5165 MCCARTY LN
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-8764
Country	:	US
Telephone Number	:	765-448-8000
Fax Number	:	765-838-4758

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

Provider Enumeration Date	:	08/21/2019
Last Update Date	:	05/18/2026

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