Healthcare Provider Details

I. General information

NPI: 1740241546
Provider Name (Legal Business Name): SANDRA R COSTA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA RANIERI DO

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N DUPONT BLVD
MILFORD DE
19963-1003
US

IV. Provider business mailing address

3 WALNUT ST SUITE 205
LEMOYNE PA
17043
US

V. Phone/Fax

Practice location:
  • Phone: 302-725-3420
  • Fax: 302-725-3430
Mailing address:
  • Phone: 717-909-0520
  • Fax: 717-909-4676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS012622
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS012622
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC2-0011328
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: