Healthcare Provider Details

I. General information

NPI: 1235732082
Provider Name (Legal Business Name): TAMIKA SANDERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 PEMBROKE AVE
BUFFALO NY
14215-3131
US

IV. Provider business mailing address

81 PEMBROKE AVE
BUFFALO NY
14215-3131
US

V. Phone/Fax

Practice location:
  • Phone: 716-906-9995
  • Fax:
Mailing address:
  • Phone: 716-906-9995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number022649696
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number022649696
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number022649696
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number022649696
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number022649696
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: