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General NPI Number Information
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NPI Number | 1689664088
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Entity Type | Individual
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Provider Name | JEANNE M SANDELLA DO
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Gender | Female
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1 IRON BRIDGE DR STE 150
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-2058
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Country | US
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Telephone | 484-622-6320
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E. OLNEY AVE PROVIDER ENROLLMENT, SUITE 400
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City | PHILADELPHIA
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State | PA
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Zip | 19120-2421
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Country | US
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Telephone | 215-254-0403
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Fax | 215-456-5926
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS010761L
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License Number State | PA
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