Provider Demographics
NPI:1588303580
Name:JANO, SANDRALIZ BERCILLA
Entity type:Individual
Prefix:
First Name:SANDRALIZ
Middle Name:BERCILLA
Last Name:JANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRALIZ
Other - Middle Name:MIGUEL
Other - Last Name:BERCILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3610 SUNNY LEA RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4712
Mailing Address - Country:US
Mailing Address - Phone:267-232-8278
Mailing Address - Fax:
Practice Address - Street 1:3610 SUNNY LEA RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4712
Practice Address - Country:US
Practice Address - Phone:267-232-8278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN756787163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse