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General NPI Number Information
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NPI Number | 1386956555
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Entity Type | Individual
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Provider Name | MRS. RENEE TALANDA SANDIFER
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Gender | Female
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Dates
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Enumeration Date | 07/05/2010
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Last Update Date | 07/05/2010
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Provider Practice Location Address
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Address Line | 355 CRAWFORD ST
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City | PORTSMOUTH
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State | VA
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Zip | 23704-2816
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Country | US
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Telephone | 757-512-5734
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Fax | 757-942-8961
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Provider Business Mailing Address
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Address Line | 1511 BASIE CRES
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City | PORTSMOUTH
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State | VA
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Zip | 23701-3931
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Country | US
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Telephone | 757-512-5734
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Fax | 757-942-8961
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 1203
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License Number State | VA
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