Provider Demographics
NPI:1063590909
Name:SLESZYNSKI, SANDRA LEE (DO)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:SLESZYNSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:OPPENHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:444 NW ELKS DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3745
Mailing Address - Country:US
Mailing Address - Phone:541-754-1150
Mailing Address - Fax:
Practice Address - Street 1:1705 WAVERLY DR SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-6952
Practice Address - Country:US
Practice Address - Phone:541-967-8221
Practice Address - Fax:800-549-1017
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31600204D00000X
ORD028866207Q00000X
ORDO28866204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIF53549Medicare UPIN