Healthcare Provider Details

I. General information

NPI: 1972703049
Provider Name (Legal Business Name): SANDRA M. TRUSKIN D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10990 KNIGHTS RD
PHILADELPHIA PA
19154-4210
US

IV. Provider business mailing address

10990 KNIGHTS RD
PHILADELPHIA PA
19154-4210
US

V. Phone/Fax

Practice location:
  • Phone: 215-632-6444
  • Fax: 215-632-1899
Mailing address:
  • Phone: 215-632-6444
  • Fax: 215-632-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC002344L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: