Healthcare Provider Details

I. General information

NPI: 1184829731
Provider Name (Legal Business Name): JILL SANDERS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 TECHNOLOGY DR UNIT #8
BRATTLEBORO VT
05301-9181
US

IV. Provider business mailing address

20 TECHNOLOGY DR UNIT #8
BRATTLEBORO VT
05301-9181
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-8989
  • Fax:
Mailing address:
  • Phone: 802-257-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: