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General NPI Number Information
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NPI Number | 1497321038
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Entity Type | Individual
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Provider Name | SANDRA LEE ROSS R.T. (VI)
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Gender | Female
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Dates
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Enumeration Date | 06/03/2021
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 1020 SANSOM ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5002
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Country | US
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Telephone | 215-955-2443
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Fax |
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Provider Business Mailing Address
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Address Line | 207 WALNUT ST
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City | JENKINTOWN
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State | PA
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Zip | 19046-3114
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Country | US
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Telephone | 267-463-7704
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Fax |
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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 | 2471C1101X
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Taxonomy Name | Cardiovascular-Interventional Technology Radiologic Technologist
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License Number | 428377
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License Number State | PA
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