Healthcare Provider Details

I. General information

NPI: 1255244885
Provider Name (Legal Business Name): SANDRA SAMBORSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 31ST ST
DOWNERS GROVE IL
60515-1235
US

IV. Provider business mailing address

8250 OCONNOR DR
RIVER GROVE IL
60171-1277
US

V. Phone/Fax

Practice location:
  • Phone: 708-543-5107
  • Fax:
Mailing address:
  • Phone: 708-543-5107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: