Healthcare Provider Details

I. General information

NPI: 1992829881
Provider Name (Legal Business Name): SANDRA L DYL R. N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 VALLEY RD
MIDDLETOWN RI
02842-5234
US

IV. Provider business mailing address

19 ANNANDALE RD
NEWPORT RI
02840-3601
US

V. Phone/Fax

Practice location:
  • Phone: 401-846-6620
  • Fax:
Mailing address:
  • Phone: 401-619-0194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN33737
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: