MEDICARE: SANDRA L DICKSON

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	343900000X	Non-emergency Medical Transport (VAN)	1541071	NJ

General Provider Information

NPI Number	:	1881171619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA L DICKSON

Provider Business Mailing Address
First Line	:	1935 SWARTHMORE AVE
Second Line	:	ST 204
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4565
Country	:	US
Telephone Number	:	732-961-6398
Fax Number	:	732-961-6399

Provider Business Practice Location Address
First Line	:	1935 SWARTHMORE AVE
Second Line	:	ST 204
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4565
Country	:	US
Telephone Number	:	732-961-6398
Fax Number	:	732-961-6399

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

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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Directions to “ SANDRA L DICKSON ” Practice Location

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