Provider Demographics
NPI:1386294338
Name:LEON, SANDRA JOANN
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JOANN
Last Name:LEON
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 1:301 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6242
Mailing Address - Country:US
Mailing Address - Phone:716-483-4439
Mailing Address - Fax:716-483-4435
Practice Address - Street 1:301 FRONT ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6242
Practice Address - Country:US
Practice Address - Phone:716-483-4439
Practice Address - Fax:716-483-4435
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY364541-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse