Healthcare Provider Details

I. General information

NPI: 1669051231
Provider Name (Legal Business Name): JORDANA SANDY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 TELEGRAPH AVE STE 110
BERKELEY CA
94705-1159
US

IV. Provider business mailing address

2850 TELEGRAPH AVE STE 110
BERKELEY CA
94705-1159
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-8140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20A23010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: