Provider Demographics
NPI:1487712949
Name:CONTI, SANDRA (PA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CONTI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HUNTLEY RD
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1843
Mailing Address - Country:US
Mailing Address - Phone:732-706-1341
Mailing Address - Fax:732-706-5833
Practice Address - Street 1:36 HUNTLEY RD
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1843
Practice Address - Country:US
Practice Address - Phone:732-706-1341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022598363AM0700X
NJ25MP00091200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical