Provider Demographics
NPI:1316543317
Name:REYNOLDS, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 LOGAN LN UNIT 8
Mailing Address - Street 2:
Mailing Address - City:ROAMING SHORES
Mailing Address - State:OH
Mailing Address - Zip Code:44084-9445
Mailing Address - Country:US
Mailing Address - Phone:440-563-9637
Mailing Address - Fax:
Practice Address - Street 1:3031 LOGAN LN UNIT 8
Practice Address - Street 2:
Practice Address - City:ROAMING SHORES
Practice Address - State:OH
Practice Address - Zip Code:44084-9445
Practice Address - Country:US
Practice Address - Phone:440-563-9637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide