MEDICARE: SANDRA BLANDON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	334411	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013905132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA BLANDON NP

Provider Business Mailing Address
First Line	:	235 PORT RICHMOND AVE
Second Line	:	SUITE 201
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-1701
Country	:	US
Telephone Number	:	718-876-1732
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 PORT RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-1701
Country	:	US
Telephone Number	:	718-876-1732
Fax Number	:	718-876-3459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	11/04/2013

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