Healthcare Provider Details

I. General information

NPI: 1033864152
Provider Name (Legal Business Name): JENNY M SANFORD ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 CAREY RD
QUEENSBURY NY
12804-7821
US

IV. Provider business mailing address

9 CAREY RD
QUEENSBURY NY
12804-7880
US

V. Phone/Fax

Practice location:
  • Phone: 518-824-8610
  • Fax: 518-824-2390
Mailing address:
  • Phone: 518-761-0300
  • Fax: 518-824-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number310673
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: