Healthcare Provider Details

I. General information

NPI: 1285820332
Provider Name (Legal Business Name): AMANDA A SANDFORD M D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2007
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE # 320
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE BLDG 320
BOSTON MA
02215-5400
US

V. Phone/Fax

Practice location:
  • Phone: 650-468-1142
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number277606
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: